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92 Cards in this Set

  • Front
  • Back

CNS consists of what 2 structures?

Brain and Spinal cord

PNS consists of

Cranial nerves autonomic nervous system


periferal nervous system

Neurons

generate and conduct nerve impulses.
When neurons are damaged they are not replaced, although we are born with extras. (Axons can regenerate-better in peripheral-less likely in CNS.)

neurogilia

support neurons. They nurish and protect neurons.
There are more neuroglias than neurons.

Nerve Impulse

Series of action potentials. It is a chemical interaction of K+ and chloride movement in and out of axons. Neurotransmitters can excite or inhibit.

Cerebrum

Area of higher level of functioning(complex mental function). Includes Basal ganglia, thalamus, hypothalamus, and the limbic system.

Basal ganglia

Learned and automatic movements Ex: blinking. (Part of Cerebrum)

Thalamus
Relay station between skeletal muscle and sensory input. (Part of Cerebrum)
Hypothalamus

Regulates temp and some aspects of autonomic and endocrine. (Part of Cerebrum)

Limbic System

Inner surface of cerebral hemisphere, has to do with emotions. (Part of Cerebrum)

Parts of Brainstem

Midbrain, Pons and Medulla

Midbrain and Pons functions

Relay center for vasomotor impulses, control alertness and awareness.

Medulla

Basic life support. Respiratory and cardiac functions.
Cardiac-slowing center.



Tip: if you don't have it, you die.

Cerebellum

Controls equillibrium & Coordination.
How do you test function of the cerebellum?

There are 2:
1. Romberg sign-stand with eyes closed. Normal person can stand 20 seconds without swaying.
2. have patient hold hands out in front flipping hands between pronate and supinate. Watch for drifting.

The peripheral nervous system includes....?

1. Spinal nerves (31 pairs)
2. Cranial nerves (12)
3. Autonomic Nervous System (Sympathetic and parasympathetic)

What is the function of the spinal nerves?
They inervate specific body regions and are motor sensory in nature.
The autonomic nervous system controls...?
Cardiac and other smooth muscles, involentary actions.
It is composed of the sypathetic and parasympathetic systems.
Sypathetic Nervous system

The fight of flight response.
Skeletal muscle vessels dialte, heart rate increases, the liver excretes extra glucose, the thyroid is stimulated, increased sweating and kidney vessels constricts.

Parasympathetic Nervous System

Inhibits. Acts to reserve energy

Circulation to the brain

To the brain is by the corotid and others in the back of the neck (patebral) and venous return is through the jugular.

what kind of symptoms would a patient describe for you to reccomend doing a nurological assessment.

hearing loss, decreased taste/smell, incontinence, difficulty sleeping, chewing, swallowing, change in sexual performance, or ADL's. Also headaches, numbness/tingling, tremors, memory loss, personality/behavior changes.

Most Neurologic Diseases affect _____?

Mobility and coordination
(dizziness, unsteady gait)

Nursing Assessment, current medications that alter the nervous system

Sedatives, analgesics, stimulants, anti-seizure, mood elevators, antidepressants

Neurological Examination: Cerebral Function

Cortical and Discriminatory interpretation-ability to see an object, recognize it's name and know it's function

Neurological Examination: The Motor System

Symmatry of muscle strength, muscle tone-palpate and look for spasticity, rigidity, flaccidity and involuntary movements

Neurological Examination: Sensory function

1.Pain and temperature (they are transmitted by the same nerve endings), if one is intact no need to test the other.
2.Touch-likely normal if pain and temp are intact. To test use touch discrimination.

Touch discrimination

Have patient close their eyes. Touch each extremity randomly with finger and ask them to point to where the are being touched. Then touch each side of the body at the same time.
Last part the patient is touched in 2 places and moved closer tother.

Glascow coma scale

Eye opening 1-4
Motor response 1-6
Verbal Response 1-5

Parkinson’s disease

a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.

define Motor neurone disease

a progressive disease involving degeneration of the motor neurons and wasting of the muscles.

define stroke

brain attack is the loss of brain function due to a disturbance in the blood supply to the brain.

Traumatic Brain

nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

Alzheimer’s disease

progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain. It is the commonest cause of premature senility.

organic brain syndrome

is a general term that describes decreased mental function due to a medical disease other than a psychiatric illness. It is often used synonymously (but incorrectly) with dementia.

define acute

In medicine, an acute disease is a disease with a rapid onset and/or a short course. [ 1] Acute may be used to distinguish a disease from a chronic form, such as acute leukemia and chronic leukemia, or to highlight the sudden onset of a disease, such as acute myocardial infarction.

define chronic

(of an illness) persisting for a long time or constantly recurring.

why use a nuro assessment

• Neurological assessment can help to detect
neurological disease or injury.
• Neurological assessment aids injury and
disease monitoring
• Neurological assessment can determine
success of treatments and care

CNS

• Purpose:
– Controls all body functions and thought
processes.
• Tasks:
– Maintains homeostasis
– Receives, interprets, reacts to stimuli
– Controls voluntary and involuntary processes,
including cognition.

layers of protection

• Protective layers:
– Scalp
– Skull
– Meninges:
• Dura mater
• Arachnoid mater
• Pia mater

DIENCEPHALON


• Diencephalon is composed of the thalamic
structures: the thalamus, the epithalamus
and the hypothalamus.
• The hypothalamus is important in:
– Body temperature regulation
– Pituitary hormone control
– Autonomic nervous system responses.

Temporal:


Hearing
– Memory
– Speech perception

occipital

vision (optic...)

parital

Somatic sensory and movement



opposite sides... stroke in the left somatosensory means a loss of feeling in the right hand side of the body.

Limbic:


emotional brain... see a spider... PANIC!

motor pathway of brain

Motor pathways of
CNS
– Pyramidal tract
– Extrapyramidal tract.


sensory pathways

Sensory pathways
– Spinothalamic tracts
– Posterior column.

blood suply brain

• Internal carotid
arteries
• Vertebral arteries
• Circle of Willis

spinal nerves

31 pairs of spinal nerves
– 8 cervical
– 12 thoracic
– 5 lumbar
– 5 sacral
– 1 coccygeal.

reflexes

A reflex action is a specific response to an
adequate stimulus, and occurs without
conscious control.
• Monosynaptic reflexes.


When a reflex arc consists of only two neurons in an animal (one sensory neuron, and one motor neuron), it is defined as monosynaptic.Monosynaptic refers to the presence of a single chemical synapse.


• Polysynaptic reflexes


Monosynaptic vs. polysynaptic[edit] When a reflex arc consists of only two neurons in an animal (one sensory neuron, and one motor neuron), it is defined as monosynaptic. Monosynaptic refers to the presence of a single chemical synapse.

types of reflexes

– Muscle stretch or deep tendon reflexes (DTR)
– Superficial reflexes
– Pathological reflexes.

healthy history of nuro

– Patient profile
– Chief complaint
– Past health history
– Family health history
– Social history.

patient profile

• Patient Profile:
– Age
– Gender
– Race.

Common chief complaints:

– Headache
– Seizure
– Syncope
– Tremor
– Pain
– Paresthesia


- Disturbances in gait (a person's manner of walking)
– Visual changes
– Vertigo
– Memory disorders
– Difficulty with swallowing or speech

Characteristics of chief complaints: nuro

– Quality
– Quantity
– Associated manifestations
– Aggravating factors
– Alleviating factors
– Setting
– Timing.

past medical history nuro

Medical history:
– Neurologic specific
– Non-neurologic specific.
Surgical history
Medications:
– Antidepressants, narcotics, anti-anxiety and
anti-seizure medications.
• Communicable diseases
• Injuries and accidents.

family history nuro

Family health history:
– Congenital defects
– Headaches
– Alzheimer’s disease.

social history nuro

• Alcohol, tobacco, drug use
• Sexual practice
• Travel history
• Work and home environment
• Hobbies and leisure activities
• Stress
• Ethnic background.

before you start nuro

Greet the patient and explain the
assessment.
2. Maintain a quiet, unhurried, self-confident
demeanour.
3. Provide a warm, quiet, well-lit environment.
4. After the mental status exam, ask the
patient to remove all street clothes and
provide a gown.
5. Begin the assessment with the patient in a
comfortable position.

equipt nuro assessment

Cotton wisp.
• Cotton-tipped applicators
• Penlight
• Tongue blade
• Vials containing odorous materials
• Vials with solutions for tasting
• Vision chart
• Snellen chart or Rosenbaum pocket
screener.

A complete assessment of the
neurological system includes assessment
of:

– Sensation
– Cranial nerves
– Motor function.

cognitive assessment

• Physical appearance and behaviour:
– Posture and movements
– Dress, grooming and personal hygiene
– Facial expression
– Affect.


where can you find questions to assess a persons cognition unrelated to a nurological assessment

falls risk assessment

cognition communication

Communication:
– Articulation, fluency, rate of speech
– Ability to read, write, follow simple commands
– Assess for aphasia, dysarthria (


difficult or unclear articulation of speech that is otherwise linguistically normal.)


, dysphonia, (


difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.)


aphonia, apraxia, agraphia, alexia.


levle of consciousness

Glasgow Coma Scale
– Motor responses and strength.

• Cognitive abilities and mentation:

– Attention
– Memory
– Judgement
– Insight
– Spatial perception
– Calculation
– Abstract reasoning
– Thought processes and content.

normal findings cognition

Posture erect, gait smooth, body
movements symmetrical.
• Clean, well-groomed, clothing appropriate
for age and weather.
• Facial expressions symmetrical and
appropriate to conversation content.


Affect appropriate to situation and cultural
norms.
• Able to produce spontaneous, coherent
speech.
• Alert, oriented to person, place, time.
• Intact cognitive abilities.


sensory assessment

Sensation should be tested early in the
neurological assessment.
• Cooperation of the patient is required.
• Fatigue may affect the reliability of
findings.
• Sensory assessment is divided into 3
sections:
– Exteroceptive sensations
– Proprioceptive sensation
– Cortical sensations.


Exteroceptive sensation:
– Light touch, superficial pain, temperature.
• Proprioceptive sensation:
– Motion, position, vibration, extinction.
• Cortical sensation:
– Stereognosis, graphesthesia, discrimination,
extinction.


Sensory Assessment: Normal Findings

• Able to accurately perceive light touch,
superficial pain, temperature.
• Able to identify changes in position of
body, vibration, common objects.
• Cranial nerves intact.
• Cerebellar function intact, gait stable.

motor system

Extrapyramidal rigidity:
– Decerebrate rigidity ( a postural change that occurs in some comatose patients, consisting of episodes of opisthotonos, rigid extension of the limbs, internal rotation of the upper extremities, and marked plantar flexion of the feet; produced by a variety of metabolic and structural brain disorders.)
– Decorticate rigidity (a unilateral or bilateral postural change, consisting of the upper extremities flexed and adducted and the lower extremities in rigid extension; due to structural lesions of the thalamus, internal capsule, or cerebral white matter.)
– Pronator drift. (refers to a pathologic sign seen during a neurological examination. [ 1] Jean Alexandre Barré is credited with having first described it thus it is sometimes known as the Barré test. A positive result indicates spasticity.)
• Cerebellar function:
– Coordination
– Station
– Gait.

define Lethargy


a lack of energy and enthusiasm.

define Obtundation


refers to less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma. The root word, obtund, means "dulled or less sharp" cf. obtuse angle.

define Stupor

a state of near-unconsciousness or insensibility.

define Coma


a prolonged state of deep unconsciousness, caused especially by severe injury or illness.

define Vertigo


a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve; giddiness.

define Syncope


emporary loss of consciousness caused by a fall in blood pressure.

define Seizure


in which the nerve cell activity in your brain is disturbed, causing aseizure during which you experience abnormal behavior, symptoms and sensations, including loss of consciousness.

define Aura


An aura is a perceptual disturbance experienced by some with migraine or seizures before either the headache or seizure begins. It often manifests as the perception of a strange light, an unpleasant smell or confusing thoughts or experiences.

define Paresthesia


an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves.

define Dysarthria


difficult or unclear articulation of speech that is otherwise linguistically normal.

define Dysphasia


language disorder marked by deficiency in the generation of speech, and sometimes also in its comprehension, due to brain disease or damage.

define Paralysis


the loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of illness, poison, or injury.

define Convulsion


a sudden, violent, irregular movement of the body, caused by involuntary contraction of muscles and associated especially with brain disorders such as epilepsy, the presence of certain toxins or other agents in the blood, or fever in children

define Nystagmus


rapid involuntary movements of the eyes.

define Anosmia


the loss of the sense of smell, either total or partial. It may be caused by head injury, infection, or blockage of the nose.

define Ptosis


drooping of the upper eyelid due to paralysis or disease, or as a congenital condition.

define Ataxia


the loss of full control of bodily movements.

define Opisthotonos


spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning.

define Decorticate rigidity

a unilateral or bilateral postural change, consisting of the upper extremities flexed and adducted and the lower extremities in rigid extension; due to structural lesions of the thalamus, internal capsule, or cerebral white matter.

define decerebrate rigidity

a postural change that occurs in some comatose patients, consisting of episodes of opisthotonos, rigid extension of the limbs, internal rotation of the upper extremities, and marked plantar flexion of the feet; produced by a variety of metabolic and structural brain disorders.

define abbey scale

For measurement of pain in people with dementia who cannot verbalise.

normal pupils will?