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148 Cards in this Set
- Front
- Back
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What does the CNS contain?
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nerves of brain and spinal cord
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What does PNS include?
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SYMPATHETIC AND PARASYMPATHETIC NERVES AND MOTORT NERVES which inervate skeletal muscle
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What has a membrane potential?
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nerve cells
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nerve cells
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inside of cell is negatively charged while the outside is positive
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What is the seperation of charge in the nerve cells made up of?
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outside cell:+ charge Na+ and K+
inside cell: - charge proteins inside the cell |
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a nerve cells membrane potential can change in response to what?
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sensory stimmuli such as sound, light, touch, and chemicals released fromm another nerve
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In response to a stimmulus, what do nerve cells do?
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open or close ion channels, called gates, which change its permeability to Na+ and K+
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positively charge Na+ ions rush where which causes what, refeerd to as what?
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inside the cell making the inside less negative, called depolarization
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how do nerves communicate?
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chemically, sending signals, or neurotransmitter via the axon
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1.What is the 1st nerve called?
2. WHat is the 2nd nerve called? |
1. presynaptic
2.postsynaptic |
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WHat is a synapse?
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point of junction between 2 neurons
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what happens if a nerve cells depolarization is great enough?
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the nerve fires an action potential
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Where does the postsynaptic cell receive the signals?
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at the synapse
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if the result is + and depolarization occurs what happens?
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postsynaptic nerve fires an action potential and transmission continues
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is the action potential exactly the same in all nerves that fire?
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yes
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how does the action potential work?
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signal travels down the nerves to stimulate another nerve, a target organ (such as muscle fiber), or a gland
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WHen are nerve cells inhibited from firing?
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when a stimulus causes the cell to become more permeable to K+ and positive K+ ions leave the cell, causing the inside of the cell to become more negative or hyperpolarized
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WHat does hyperpolariztion prevent?
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the nerve from firinng an action potential
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the axon is covered by what?
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fatty insulation called myelin
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are nodes covered by mylein?
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no
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Salutatory conduction
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when action potentials jump very fast from node to node
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if the myelin sheath is destroyed as with MS, WHat happens?
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transmission of an action potential slows because it is forced to spread dow the entire axon
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When nerve transmission is interrupted as with spinal cord injury, what happens?
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the brain cant communicate with muscles
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if synaptic transmission is interrupted what happens?
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brain cells and other nerve cells cant communicate
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What are the parts of the brain?
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cerebrum
hemispheres right and left frontal lobe parietal lobe temporal lobe occipital lobe cerebellum brain stem |
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frontal lobe
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higher intellectual functions, social behavior, personality
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parietal lobe
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interprets sensory input
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temporal lobe
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hearing, taste and smell
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occipital lobe
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vision
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cerebellum
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provides equilibrium and muscle coordination
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brain stem
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midbrain, pons and medula oblongota, controls basic body functions and relays impulses to and from spinal cord
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descending tract
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anterior portion of the cord carrying motor information
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ascending tract
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posterior portion of the cord, carrying sensory info
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how many segments are in the spinal cord?
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31
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1.cervical
2.thoracic 3. lumbar 4.sacral 5.coccygeal |
1. 8, neck and upper extremities
2. 12, thoracic and abdomen 3. 5, lumbar and lower extremities 4.5, lower extremities, urine and bowel control 5. 1 |
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WHat does the PNS do and what does it contain
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carrys info to and from CNS,
motor and sensory nerves |
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WHat does the autonomic nervous system do and what does it contain?
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regulates bodys internal envirnoment,
contains sympathetic and parasympathetic |
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1.parasympathetic
2. sympathetic |
1. controls normal body functioning for day to day activity ex. increases muscle tone, maintains secretions, maintains heart rate within normal limits, maintains peristalsis
2. prepares body for figh or flight, used only as needed |
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What are the 12 cranial nerves?
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olfactory, optic, oculomotor, trochlear, trigeminal, abduccens, facial, auditory, glossopharyngeal, vagus, spinal, hypoglossal
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What is the job of the nervous system?
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coordinates and controls all activities of the body
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Specific jobs of the nervous system
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1. receives internal and external stimuli
2.processes info to determine appropriate response 3. transmits info over varied motor pathways to effector organs 4. change in LOC: restlessness, disorientation, confusion, lethargy, stupor 5. pupils: dilated ipsilaterally, (on same side) reacts slowly to light 6. abnormal motor activity: contralateral (opposite side) hemiparesis 7. abnormal reflexes-hyper or hy 8. vitals within normal parameters 9. LOC: semicomotose, coma 10. pupils: dilated bilaterally and fixed, no reaction to light 11. motor function 12vitals |
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motor function of the nervous system:
1. decorticate posture 2. decerebrate posture |
1. lesion at or above brain stem, pt is rigidly still with arms flexed, fists clenched, and legs extended
2. flaccid muscles at end stage, rigid body position assumed by a pt who has lost cerebral control of spinal reflexes, usually as a result of an intracranial catastrophe.Pts arms are stiff and extended, the forearms are pronated, and deep tendon reflexes exagerated. |
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vital signs
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increased systolic pressure to result in a widened pulse pressure, decreased respirations with bradycardia, temp initially may rise then fall below normal parameters
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Huntington's disease
1. What type of trait 2. WHat age 3. sx 4. how long till pt dies 5. why does pt die 6. tx |
1. autosomal dominant
2. 30-50 3. subtle dementia, irritability, antisocial, chorea 4. 10-15 years after onset 5. atrophy of caudate nucleus and cerebral cortex 6. D2 receptor antagonist (haloperidol) |
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Parkinsonism
1. Why does it occur 2. what happens 3. sx 4. tx 5. WHat if meds dont work? 6. what is it |
1. idiopathic
2. loss of dopaminergic cells in substantia nigra 3. pin rolling tremor, masklike face, lack of arm swing when walkin, cogwheel rigidity, difficulty initiating movement, small shuffle steps w/ increasing speed (festinating gate), muscle stiffness, rigiditydecrease in cerebral blood flow causes dimentia 4. levadopa (dopamine precursor), amantadine, bromocriptine(dopaminergic agonist), benzotropine (anticholinergic) 5.thalamotomy:destroys part of the thalmus to relieve excessive muscle contractions 6. chronic and progressive degenerative disease of the nervous system affecting cells of the brain that control and regulate movement. The neurotransmitter dopamine is depleted |
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Lou Gehrig's Disease
1. What is it 2. Initial sx 3. Later sx |
1. Progressive loss of anterior horn cell function
2. lower motor neuron dysfunction, with hand and foot weakness and atrophy, assymetric progression, no sensory abnormalities 3. Upper motor neuron dysfunction with muscle spasticity, DTR, extensor plantar reflexes |
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Tay Sachs Disease
1. What type of trait 2. who gets it 3. why does a person get this 4. signs/sx 5.When do they die by |
1. autosomal recessive
2. eastern europe jews and french canadians 3. absence of hexosaminidase A 4. cant metabolize lipid gangliosides, build up in brain, progressive dev. delay, paralysis, blindness, dementia 5.age 4 |
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ms
1.WHAT IS IT 2. who does it affect 3. age 4. how does it come on 5. diagnosis 6.what climate is most common 7.cause 8. What are the 3 types 9.sx 10.complications 11.interventions 12.what should be avoided 13.what should be encouraged |
1. progressive demyelinating disease of CNS with demyelination of brain and spinAL CHORD, impairing transmission of nerve impulses, neurologic disease
2. women more than men 3. 20-40 4. gradual and variable 5. lumbar puncture to see CSF=mild proteins, mild lymphocytes, oligocolonal bands, abnormal antibody, increased gamma globulin MRI=multi plaques in white matter/demyelinization 6. northern temperate climate zones 7.unknown 8. a. relapsing-remitting(complete recovery between relapses)-maybe r/t emotional/physical stress b. chronic progressive course c. benign-w/out sx 9. fatigue, weakness, numbness, loss of balance and coordination, blurred vision, spastic weakness of extremities, parethesias, loss of abdominal reflexes, tremors, sensory dysfunction, bladder, bowel and sexual problems 10. UTI, constipation, pressure ulcers, dependent pedal adema, and pneumonia 11. immunosupressants(interferon, cyclophosphamide) and corticosteroids are used to modulate the immune response and reduce progression |
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Guillian-Barre Syndrome
1. what is it 2. when does it occur 3. is it common 4. sx 5. What speeds recovery 6. What drug is contraindicated |
1. polyneuropathy
2. after mild viral illness, inoculation, or surgery 3. most common acquiired demyelinating disorder, progressive bilateral weekness of legs, proximal weakness, abnormal DTR, instability of temp and BP, CSF=protein with normal pressure, glucose and cell numbers 5.plasmaphresis speeds recovery 6. corticosteroids |
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Cerebral Palsy
1. what is it 2. risks 3. Sx |
1. CNS damage before age 5
2. prematurity, IUGR, inutero complications, neonatal jaundice, birth trauma, asphyxia, spastic syndrome 3. DTR, tone, weakness, toe walking, scissors gait |
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Myasthenia Gravis
1. WHat is it 2. age 3.gender 4.sx 5. tx 6. drugs if unresponsive to tx |
1. autoimmune, antibodies against acetylcholine receptors at neuromuscular junctions
2. 20-40 3. women 4. ptosis, diplopia, dysarthria, enhanced muscle fatigue, thymoma on chest x ray 5. exogenous anticholinesterase, thymectomy in pts less than 60 6. steroids or azathioprine |
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Leg-Calve Perthes Disease
1. WHat is it 2. unilateral or bilateral 3. gender/age 4. possible comp. 5. etiology 6. 4 stage course in how long? 7. sx 8. tx |
1. vascular necrosis or degeneration of the femoral head leading to a flattened femoral head
2.unilateral 3. boys 4-10 4. permanent disability, osteoarthritis 5. unknown, pos. r/t metabolic, infectious, oor traumatic factors 6. 3-4 years a. vascular interruption causing necrosis b. new blood supply causes bone resorption and new bone cells deposited. (deformity) c. new bone replace necrotic bone, femoral head reforms d. healing and regeneration which fixes the joints shape 7. limp that progressively worsens, persisten groin, thigh, or knee pain (relieved by rest), affected leg is shorter, decreased range of mootion in affected extremity 8. SPICA CAST post op worn for 2 months, (new)cast care1.air dry2.teah pt to keep dry3.rub skin with alcohol daily4.petal cast5. no powder(bacteria from perspiration mix), pt supine, abduction pillow to prevent dislocation of prosthesis, avoid acute flexion of the hip, crossing of the legs, sitting in low chairs or toilet, or riding in a car to prevent inj |
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Post op:Knee arthroplasty
1. keep in what position 2. why is Continous passive motion used 3. can u use walking devices |
1.knee imobilized in extension with dressing, leg elevated on pillow with ice applied to control swelling and bleeding
2. to facilitate healing and restore joint mobility 3.crutches, walker, cane when ordered by orthopedic surgeon |
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Hunitingtons disease
1. what is it 2. age 3. pts usually die within how long? 4. What type of trait 5. what type of tx 6. pts usually die from what |
degeneration in the cerebral cortex (thinking, memory, perception, & judgement) and basal ganglia causing progressive chorea (involuntary and irregular movements) and mental deterioration that terminates in dementia
2. 35-45 3. 10-15 years 4. genetic autosomal 5. palliative 6. heart failure, pneumonia, infection, or choking |
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What are the clinical manifestations of Huuntingtons?
WHat are the medical Interventions? |
chorea-abnormal involuntary movements involving constant writhing, twisting, facial tisks, and grimaces, disorganized gait, loss of bowel and bladder control, cognitive impairment intellectually and w/ unintelligable slurred speech, emotional changes (early) anger, depression, suicidal ideation, apathy or euphoria. (progression) nervous, clumsy, irritable or impatient. (end) hallucinations, delusions and paranoid thinking usually precede the appearance of disjointed movements
phenothiazines, butyrophenones, and thioxanthenes predominantly block dopamine receptors, improving chorea. Antidepressant and antipsychotic drugs |
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Myasthenia gravis
1. What is it? 2. What age for A. men B.women 3. sx 4.complications a. myasthenic chrisis b. cholinergic crisis c. what do both things cause? 5.dx 6. tx |
1. chronic neuromuscular autoimmune disease characterized by rapid exhaustion of voluntary muscles during activity and profound muscular weakness and fatigue after activity
2. A. after 40 B. 15-35 3. diplopia, sleepy, mask-like expression, dysphagia, drooling, weakness in arm and hand muscles, legs less often, progressive weakness of the diaphragm, profuse sweating 4. A. sudden increase in weakness sx. ptosis, decreased BP, absent cough reflex, and incontinence B. overmedication with anticholinesterase. sx-n/v, ab cramps, miosis, and blurredvision c. resp distress, weakness and difficulty swallowing and speaking 5. injection of tensilon, improvements of muscle strength are positive to confirming the dx 6. anticholinesterase meds-increases response of muscles to nerve impulses and improves strength. Atropine given as antidote if overdosed, immunosuppressive tx-reduce production of the anti-receptor antibody, plasma exchange to reduce the circulating antibodies, surgical removal of thymus cause substant |
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more than 75% of seizures begin after what age for what reason?
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20, ideopathic
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What are the 3 types of seizures?
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petit mal, grand mal, tonic clonic
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What does an aura indicate?
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pre-seizure warning sensation (flash of light or hearing a sound)
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Simple partial seizure
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only one hemisphere involved, may or may not involve LOC, dizziness, unusual or unpleasant sights, sounds, odors, or taste
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complex patial seizure
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begins in one focal area but spreads to both hemipsheres, amy or may not have motion, may experience excessive emotions of fear, anger, elation or irritability, usually not remembered and include postictical sx
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grand mal seizure
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involves both hemispheres of the brain and intense rigidity of the entire body followed by jerking movements of the entire body. Usually lasts from 1-2 minutes
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prolonged grand mal seizure is known as what?
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status epilepticus, could be fatal without intervention
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What is postictal sx?
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occurs after a sizure, confusion, hard to arouse, sleeping for hour
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WHat meds are given for seizures?
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tegretol, mysoline, dilantin, zarontin, depakene, phenobarbital
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WHat surgeries could be needed to stop reoccuring seizures?
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intracranial tumors, abscess, cysts, vascular abnormalities
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What is the general tx of a seizure?
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1.patent airway
2. iv line for meds and blood work 3. valium slow IV push to halt seizure activity 4. anticonvulsant to maintain a seizure free state 5. monitor vital signs and neurological state 6. position pt to a side lying position 7. fascilitate rest 8. avoid stimulation like caffeine, bright flickering lights, stress, and alcoholic beverages |
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head injuries to the scalp can include what?
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abrasion, contusion, laceration, avulsion and skull fracture
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Skull Fx
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battle signs=discoloration over mastoid bone;blood draining from ears
bruising of orbit, CN palsies, CSF leakage from ears and nose |
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Concussion
1.WHat is it 2. Coup 3.contrecoup 4.frontal involvement sx 5. temporal |
1. transient LOC
2. bruising under site of injury 3. bruising on side contralateral to injury, temporary loss of neurologiic fx with no apparent structural damage, diziness, spots 4. bizarre irrational behavior 5. temporary amnesia or disorientation |
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contusion
1. What is it 2. Sx |
1. bruise of the brain with possible hemorrhage
2. unconscious, incontinence of bowel or bladder, abnormal motor function, abnormal eye movements and increased ICP. May recover completely but can experience residual H/A and vertigo, impaired mentality or epilepsy. |
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Intracranial Hemorrhage
1.What is it? 2.sx r/t what? 3. sx? 4. Sx are delayed until what? |
1. hematoma formation within the cranial vault most seriosu complication of head injury
2. extent of injury, and degree of ICP 3. LOC:decreased or absent pupilary reaction, decreased strength-total paralysis of motor function, increased ICP with widening pulse pressure , bradycardia, altered temp regulation, slowed respirations, incontinence of bowel and bladder, posturing 4. hematoma is large enough to cause distortion and herniation of the brain and ICP |
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1.decerebrate posturing term
2. Indicates what |
1.all extremities rigidly extended with hyperpronation of forearms and plantar extension. (injury is to the midbrain or pons
2. severe damage and poor prognosis |
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Decorticate posturing term
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arms adducted and rigidly flexed toward chest
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What are the 3 types of intracranial hemorrhage
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epidural, subdural, intracranial
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epidural
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blood collects in the space between the skull and duramater, caused by trauma or ruptured aneurysm
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subdural
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blood between the dura and underlying brain (acute, subacute, or chronic)
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intracranial
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bleeding in the brain itself
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What assesments should be done ofr head injury?
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1.history of injury
2. LOC-gloscow coma scale |
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Gloscow coma scale is based on what?
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eye opening ability, best verbal response, and motor response to stimuli
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what is increased ICP?
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incease in cranial contents from cerebral edema or bleeding,, diminished blood flow decreased brain function due to hypoxia and anoxia
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what is the normal ICP?
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0-15 mmHG
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Craniotomy
1.What is it? 2. most frequent pain med? 3. avoid what and why? |
1. opening in skull to decrease ICP, ciscourage coughing and prevent infection-direct abcess of brain
2.codeine 3.restraints-icp, narcotics-depressed respiratory function and alters LOC, avoid bending, coughing, sneezing, lifting, straining, and vomiting (increased ICP) |
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spinal cord injury
1. r/t what 2. most common in who 3. most common in what part 4. assessment |
1. MVA, falls, sporting and industrial accidents and gunshot wounds
2.males, <30 3. 5th, 6th, 7th cervical, 12th thoracic and 1st lumbar 4. hx of injury, glasgow coma scale, and assessment of spontaneous movement and strength of extremities, speech and pupil response to light |
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5. acute phase management
6.management of comp. a.spinal shock b. autonomic dysreflexia |
5. o2, heart stability, spinal immobilization, pharmacology-high dose steroids and mannitol to counteract cord edema
6. a. occurs shortly after injury and recovery make take 1-12 weeks, GI decompression to treat bowel distention and paralytic ileus, foley to treat urinary retention b. remove trigger stimuli, place the pt in sitting position to lower BP, empty bladder, remove fecal mass |
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Gait abnormalitys
1.Cerebellar Lesions 2. corticospinal 3.extrapyramidal 4.motor system |
1. trucal ataxia, broad based, unsteady, irregular;cant turn
2. affected leg circumducts as it steps forward, scissors if bilateral 3. festinating gait, flexed posture, small rapid steps, no arm swing 4. footdrop-anterior tibial;calf muscle-cant toe walk, pelvic muscle-waddling gait |
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Stroke
1.also referred to as? 2. what is it 3. how does 02 deprivation occur 4.WHat are the 2 types |
1. brain attack, CVA
2. occurs when brain cells die from 02 deprivation 3. blood flow to brain is blocked by clot, or if vessels are damaged 4. hemorrhagic and ischemic |
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hemorrhagic stroke
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when a blood vessel in the brain bursts due to *HIGH BP, atherosclerosis, or congenital malformation
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how does a burst vessel work?
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causes bleeding into the brain and decreased blood flow in the damgaed vessel. Blood build up increases pressure in the brain, damaging nerve cells and collapsing smaller vessels
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ischemic stroke
1.term 2.3 categories 3.fast or slow 4.aka 5.caused by what 6.most common cause |
1.occurs when blood flow through a vessel is blocked leading to cerebral infarction.
2. thrombotic, thromboembolic, and embolic 3.slow 4.occlusive, clot 5. cerebral thrombosis, or embolism within the cerebral blood vessels 6.atherosclerosis |
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when does a thrombotic stroke occur?
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when flow in a blood vessel in the brain is obstructed by arteriosclerosis
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when does a thromboembolic stroke occur?
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when a clot breaks off from an arteriosclerotic plaque, and lodges in a down stream vessel, blocking blood flow
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when does an embolitic stroke occur?
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when a clot travels to the brain from elsewhere in the body. pt with a fib or who has suffered a heart attack are at high risk of embolic stroke. This is because slow, irregular, or interrupted blood flow has a tendency to clot
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Transient Ischemic Attack
1.what is it 2. is it temporary |
1.precursor to a thrombotic stroke or short term embolus
2. temporary, and improves before cells die |
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CVA
1. definition 2.r/f 3. five classes of stroke by severity |
1. decreased blood supply to the brain
2. hypertension, uncontrolled, smoking, obesity, increased blood cholesterol and tryglicerides, chronic a fib 3. A. TIA B. reversible ischemic neurological deficit C. partial nonprogressive stroke D. Progressive Stroke E. completed Stroke |
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Transient Ischemic Attack
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1. warning sign of stroke
2. localized ischemic event 3. produces neurological deficits lasting only minutes or hours 4. full functional recovery within 24-48 hrs. |
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Reversible Ischemic Neurological Deficit
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1. similiar to Transient Ischemic Attack
2.findings last between 24 hours and 3 weeks 3.usually full functional recovery within 3-4 weeks |
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partial nonprogressing stroke
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some neurological deficit but stabilized
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progressing stroke
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1.stroke in evolution
2.deteriorating neurological status often with grand mal seizure activity with residual neurological deficits |
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completed stroke
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your done
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Hemorrhagic stroke
1.slow or abrupt onset? 2. WHat are the 4 types of hemorrhagic strokes |
1. abrupt
2. intracerebral hemorrhagic stroke, subarachnoid hemorrhage, epidural bleeds, subdural bleeds |
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intracerebral hemorrhagic stroke
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1. blood vessles rupture with a bleed into the brain
2. occurs most often in hypertensive older adults 3. can also result from anticoagulant or thrombolytic therapy |
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subarachnoid hemorrhage
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1. most often caused by rupture of saccular intracranial aneurysms
2. more than 90% are congenital aneurysms |
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epidural bleeds
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1.arterial is involved
2. often LOC for a short period or called transient 3. recall clue:associate that "e" in epidural and "a" in artery are together at the top of the alphabet |
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subdural bleeds
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1. vein is involved
2. may not be evident until months after inital trauma 3. recall clue: associate that "s" in the subdural and "v" in the vein are together at the bottom of the alphabet |
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With an occlusive stroke findings depend on what?
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the artery involved
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1. internal carotid artery
2. anterior cerebral artery 3. middle cerebral artery 4. posterior cerebral artery 5. vertebrobasilar artery |
1. contralateral
2. perseveration, contralateral, hemaperesis, hemiplegia, urinary incontinence, gait:apraxia, confusion 3.contralateral, hemiparesis/hemiplegia, cerebellar ataxia, intention tremors, dystonia 4. contralateral hemiparesis/hemiplegia, cerebellar ataxia, intention tremors, dystonia 5. dysarthria, dysphagia, diplopia, facial palsy, and numbness, vertigo, headache, vomiting, weak limbs, altered LOC |
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Right CVA
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left hemiplegia, sensory perceptual deficits, deficits in visual-spatial processing, impaired awareness of body space
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Left CVA
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right hemiplegia, impaired verbal skill or other language difficulties
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hemorrhagic stroke
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severe headache, transient loss of consciousness, vomiting photophobia, low grade fever
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What are the dx for strokes?
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1.history and physical exam
2. CT scan 3. MRI 4. doppler echocardiography flow analysis 5. carotid artery duplex doppler ultrasonography 6. EEG-shows electrical activity 7. lumbar puncture-shows if blood found in cerebral spinal fluid 8. cerebral angiography-shows blood flow, may be done with or without contrast |
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WHat is the management for strokes
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to prevent or minimize the damaging effects of stroke; dependent on the type of CVA, which depends on expected outcomes, orevent or minimize damaging effects of stroke, Care is dependent on type of CVA
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Occlusive Stroke
1. pharmacologics 2. surgery |
1. thrombolytics
anticoagulant therapy:heparin, coumadin antiplatelet therapy:aspirin, dipyridamole platelet aggregation inhibitor:clopidogrel(plavix), ticlopidine HCL (ticlid) steroids 2.bypass |
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Hemorrhagic stroke
1.pharmacologics 2. how to tx? |
1. antihypertensive agents
systemic steroids: decadron osmotic diuretics:mannitol antifibrinolytic agents:amicar vasodilators alpha blockers beta blockers anticonvulsants 2. surgical excision of aneurysm |
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What tx are common to both types of strokes?
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care based on findings
occupational therapy speech therapy nutritional support |
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What are the NSG interventions in an acute stage of stroke?
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1.maintain airway patency;if grandmal seizure activity:note time, length, behaviors
2. monitor neuro vital signs 3. maintain adequate fluids 4. provide activity as ordered 5. perform passive and/or active ROM 6. HOB elevated 15-30 degrees with client turned or tilted to unaffected side 7.maintain proper body allignment 8.administer meds as ordered 9. care for post op client as indicated |
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What care should be provided for client with Increased ICP?
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1.monitor neuro vital signs as ordered
2. maintain fluid restriction as ordered 3. raise HOB at 30-45 degrees, avoid 90 degrees since pressure in hip area increases ICP 4. prevent any activities increase ICP such as:straining, coughing, vomiting, any restrictive clothin around neck, neck rotation, flexion, extension, anxiety, pushing up in bed with heels pulling on rails when turning 5. observe for herniation syndrome 6. monitor for changes in ICP 7.admin o2 as ordered 8. institute seizure precautions 9. provide for care of the unconscious client |
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What is the Long term care of client with stroke?
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1. monitor ellimination patterns
2. teach/evaluate use of supportive devices 3. maintain a safe environment 4. prevent the effects of immobility 5. maintain adequate nutrition in light of feeding and swallowing problems 6. assist w/ eating and ADL's as indicated 7.provide emotional support 8.provide methods of communication for client with aphasia |
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neurologic abnormalities in the left (dominant) hemisphere
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aphasia, right hemiparesis, right sided sensory loss, right visual field defect, poor right conjugate gaze, dysarthria, difficulty in reading, writing, or calculating
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right nondominant hemisphere
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neglec of the left visual space, left visual field defect, left hemiparesis, left sided sensory loss, poor left conjugate gaze, extinction of left sided stimuli, dysarthria, spatial disorientation
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brainstem /cerebellum/posterior hemisphere
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motor or sensory loss in all 4 limbs, crossed signs, limb or gait ataxia, dysarthria, dysconjugate gaze, nystagmus, amnesia, bilateral visual field defects
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small subcortical hemisphere or brain stem (pure motor stroke)
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weakness of face and limbs on one side of the body without abnormalities of higher brain function sensationn or vision
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small subcortical hemisphere or brain stem (pure sensory stroke)
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decreases sensation in face and limbs on one side of the body w/out abnormalities of higher brain function, motor function, or vision
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1. closed head injury
2. open head injury |
1. nonpenetratring, no break in integrity of skull
2. skull broken with brain exposed |
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severity of head trauma
1.mild 2.moderate 3.severe |
1. only momentary loss of counsciousness with no neurological sequelae
2. momentary loss of consciousness with a change in neurological function wich iis usually not permanent 3. decreased LOC with serious neurological impairment and sequelae |
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4.4 types of skull fractures
1.Linear 2. Depressed 3. Basal 4.Concussion |
1. simple break in bone, no displacement of skull
2. part of skull is pushed in 3. at base of skull, may extend into orbit or ear; ear or nose may leak CSF;most difficult to verify by xray 4.temporary loss of neurologic function but complete recovery |
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epidural hematoma
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1.usually something lacerated in the blood vessels of the middle meninges
2. since this is arterial bleeding, risk of death is greatest 3. client commonly looses consciousness after injury then is lucid, then LOC drops quickly with the next 24 hours |
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subdural hematoma
1. term 2. acute 3.subacute 4. chronic |
1. something has lacerated the blood vessels crossing the subdural space
2. findings surface in 24-72 hrs after injury w/rapid neurologic deterioration 3. findings surface 72 hours to 2 weeks after injury with a slower progression of deterioration 4. gradual clot formation over time, possibly months with minimal deterioration |
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Progression of skull fracture injury
1.onset 2. what happens next 3. scarring |
1. contusions and lacerations of nerve cells
2. gradual demyelinization of affected nerve fibers results in neuron death 3. meninges adhere to injured area of brain |
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complications of skull fracture
1. edema 2. SIADH 3. Diabetes Inspidus |
1. results in increased intracranial pressure, results directly from cerebral ischemia, anoxia, and hypercapnia
2. too much ADH is produced, water is excessively retained-hemodilution, urinary output decreases, urine specific gravity increases effect, more common in chronic phase of care after a head injury 3. results from a decrease release of ADH and body excretes too much fluid, the increase in urinary ouput results in a low specific gravity, more common in the acute phase of head injury |
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stress ulcer
1. head injuries activate what 2 systems? 2.stimulation of the sympathetic system leads to what? 3. stimulation of the parasympathetic system leads to what? 4. steroid therapy can lead to the development of what? 5. WHy? |
1. sympathetic and parasympathetic systems
2. gastric ischemia from vasoconstriction 3.increased release of hydrochloric acid into the stomach 4. ulcers 5. increase HCL acid |
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Seizure Disorders
WHy can they occur? |
infection in brain, lungs, urinary system, hyperthermia, hypothermia
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WHat are the Findings in head trauma 1-5
6. What does projectile vomiting indicate |
1. degree of neurological damage varies with type and location of injury
2. restlessness and irritability-initially 3. decreased LOC-lethargy, difficulty with arousal 4. headache 5. nausea and vomiting 6. ICP |
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WHat are the dx in head trauma?
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history and physical exam, ct scan, MRI, EEG
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WHat is the nsg management in head trauma?
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reduce or minimize increases in intracranial pressure and protect the nervous system
tx for findings:seizure, fever, infection, speech, physical, and occupational and behavioral therapy |
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What are 3 meds often used for ICP?
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1. osmotic diuretics;mannitol-iv drip or push
2. steroids:decadron-iv push 3. barbiturate coma may be induced to treat refractory refractory increased ICP --surgery for correction of underlying cause |
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WHat are seizure precautions?
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bed rest, padded side rails, suction machine at bedside, o2 at bed side
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care of client with increased ICP
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1. monitor neuro vitals
2. maintain fluid restrictions 3. raise HOB 30-45 degrees, avoid 90 since hip pressure increases ICP 4. Prevent any activities that increase ICP:straining, coughing, vomiting, restricitve clothing on neck, neck rotation, flexion, extension, anxiety, pushing up in bed with heels, pulling on rails when turning, observe for herniation syndrome, monitor for changes in intracranial pressure, admin o2 as ordered, institute seizure precautions, provide care for unconscious client 5.observe for herniation syndrome 6. monitor for changes in ICP 7. admin. o2 as ordered 8. institute seizure precautions 9. provide for care of unconscious client |
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Seizure care
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1. do not leave client who is seizing
2. break clients fall-assist to horizontal position on bed or floor 3. loosen tight clothes around neck and chest 4. remove objects near client 5. place pillow under head 6. place pts head in lateral position to maintain airway 7. place nothing in clients mouth 8. cover client if possible 9.Document a.type of seizure-describe behavior b. duration c. activity during and if incontinent d.if any precipitating factors e. clients response-immediate, then at 15 minute intervals until stability is established |
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Hunt and Hess Classification of Subarachnoid Hemorrhage
1.Grade 1 2. Grade 2 3. Grade 3 4.Grade 4 5. Grade 5 |
1. asymptomatic or minimal headache and slight nucal rigidity
2. moderate to severe headache, nucal rigidity, no neurologic deficit other than cranial nerve palsy 3. drowsiness, confusion, or mild focal deficit 4. stupor, moderate to severe hemiparesis, possible early decerebrate rigidity, and vegetative disturbances 5. deep coma, decerebrate rigidity, moribund appearance |
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Glasgow coma scale is based on what 3 responses?
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eye opening, verbal, motor
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eye opening
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1.spontaneous-open with blinking at baseline= 4 points
2. to verbal stimuli, command, speech= 3 points 3. to pain only (not applie to face) = 2 points 4. no response = 1 point |
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verbal
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1.oriented = 5 points
2. confused conversation, but able to answer questions = 4 points 3. inappropriate words = 3 points 4. incomprehensible speech = 2 points 5. no response= 1 point |
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motor response
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1. obeys commands for movement= 6 points
2. purposeful movement to painful stimulus = 5 points 3. withdraw in response to pain= 4 points 4. flexion in response to pain (decorticate posturing) =3 points 5. extension response in response to pain (decerebrate posturing)=2 points 6. no response= 1 point |
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coma
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no eye opening, cant follow commands, no words (3-8)
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head injury classification
1.severe head injury 2. moderate head injury 3. mild head injury |
1. GCS score of 8 or less
2. GCS score of 9-12 3.GCS score of 13-15 |
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Brain lesions and there effect
1.occipital lobe 2.thalamus 3.pineal gland 4.internal capsule 5.basal ganglia 6. pons 7. broca's area 8.precentral gyrus 9. superficial parietal lobe |
1. homonymous hemianopsia, partial seizures with limited visual phenomena
2.contralateral thalamus pain, contralateral hemisensory loss 3. early hydrocephalus, papillary abnormalities, parinauds syndrome 4.hemisensory loss, homonymous, hemianopsia, contralateral hemiplegia 5.contralateral dystonia, contralateral choreoathetosis 6. diplopia, internal strabismus, VI and VII involvement, contralateral hemisensory and hemiparesis loss, issilateral cerebellar ataxia 7. motor dysphasia 8.jacksonian seizures, generalized seizures, hemiparesis 9.receptive dysphasia |
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1.olfactory
2. optic 3.oculomotor 4. trochlear 5. trigeminal 6. abducens 7. facial 8. vestibulocochlear 9. glossopharyngeal 10. vagus 11. spinal accessory 12. hypoglossal |
1. smell
2.sight 3.ptosis(drooping of eyelid),deviation of eyeball outward, pupil dilation, double vision 4. rotation of eyeball upward and outward, double vision 5. sensory root:pain or loss of sensation in the face, forehead, temple, and eye, motor 6. deviation of the eye outward , double vision 7. paralysis of all muscles of one side of the face 8. deafness, ringing in ears, diziness, nausea and vomiting, reeling 9. disturbance of taste, difficulty in swallowing 10. disease of vagus nerve is usually limited to one or more of its divisions. paralysis of the main trunk on one side causes hoarseness and difficulty swallowing and talking . the commonest disease of the vagus nerve is of its left recurrent branch, which causes hoarseness as its principal manifestation 11. drooping of the shoulder, inability to rotate the head away from the affected side 12. paralysis of one side of the tongue, deviation of the tongue toward the paralyzed side, thick speech |
