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What are the 3 Nervous systems in the human body Central Nervous System (CNS), Peripheral Nervous System(PNS), and Autonomic Nervous System (ANS) What is the function of the CNS to coordinate and control the body What makes up the CNS Brain, Spinal Cord, Neural Pathways What is CSF Cerebral Spinal Fluid; it is formed in the ventricles of the brain What are the 3 functions of CSF 1. Helps to cushion the brain and spinal cord, 2. Nourishes the entire CNS, 3. Removes waste materials What are the 4 different parts of the brain Cerebrum; Diencephalon; Brain Stem; Cerebellum Explain the Cerebrum higher level functions such as memory, perception, communication, initiation of voluntary movements What are the 4 lobes of the cerebrum frontal, parietal, temporal, and occipital What is the front lobe in control of directs voluntary, skeletal actions, influences communication, emotions, intellect, reasoning, ability, judgement & behavior Where is Broca's area located and what is it responsible for Frontal lobe and responsible for speech What is the parietal lobe in control of Sensory, tactile sensations(touch, pain, temp, shapes, and 2-point discrimination What is the temporal lobe in control of Auditory Where is Wernicke's area & what is it responsible for Temporal, and is responsible for interpreting auditory stimuli What is the occipital lobe in control of visual What makes up the diencephalon Thalamus & Hypothalamus Explain what the thalamus controls impulse relays of sensation, spacial sense, consciousness, sleep and alertness Explain what the hypothalamus it regulates H2O balance, appetite, pain perception, and emotional stress Consists of the midbrain, pons and medulla oblongata Brain stem Describe the midbrain It is the relay center for ear and eye reflexes Describe the pons it controls various reflex actions Describe the medulla oblongata controls & regulates respiratory functions, heart rate & force, and blood pressure What are the primary functions of the Cerebellum coordination, equilibrium, muscle tone, smoothing of voluntary movements How many hemispheres does the cerebellum have 2 What are the functions of the Spinal Cord conducts sensory impulses up ascending tracts to neurons that stimulate glands and muscles throughout the body; simple reflex activity What are the 2 types of Neural Pathways Motor pathways & Sensory pathways Explain the 2 types of motor pathways Corticospinal / Pyramidal Tract & Extrapyramidal Tract Define the Corticospinal / Pyramidal Tract voluntary movements with skill and purpose (writing) Define the Extrapyramidal Tract Maintenance of muscle tone and body control (automatic), non thinking) walking Define the sensory pathways sensation travels in the afferent fiber in the peripheral nerve, then through the posterior (dorsal) root & into the spinal cord Spinothalmic Tract & Posterior(Dorsal ) columns types of sensory pathways Spinothalmic Tract pain, temp, itch and crude(harsh) touch Posterior (dorsal) columns position, vibration and fine touch What are the 2 types of nerve fibers Somatic & Autonomic Explain the somatic nerve fiber carry CNS impulses to voluntary skeletal muscles & conscious control Explain the autonomic nerve fiber carry CNS impulse to smooth, involuntary muscles & unconscious control How many Crainal Nerves do we have 12 pairs How many Spinal & Peripheral nerves do we have 31 pairs The autonomic system is divided into 2 parts, what are they Sympathetic & Parasympathetic Explain the sympathetic autonomic system is activated during stress and elicits responses to potential danger(flight or fight) Explain the parasympathetic autonomic system functions in a complementary & counterbalancing manner to conserve body resources & day-to-day functions or restore normal body functions Explain the upper motor neurons Located completely within the CNS; convey impulses from motor areas of the cerebral cortex to the lower motor neurons What are a couple of the diseases associated with the upper motor neurons CVA, Cerebral palsy, multiple sclerosis Explain the lower motor neurons located mostly in the PNS; any movement from the spinal cord to the muscles What are a couple of the diseases associated with the lower motor neurons Spinal cord lesions, poliomyelitis, ALS ataxia an unsteady gait What are some of the most common complaints that could be from problems with CNS/PNS/ANS Seizures; headaches; LOC; weakness or parethesia; gait / coordination; tremors; dizzines/ vertigo; difficulty swallowing; difficulty speaking; bowel/bladder control; memory loss What is a flag with concerns to a headache "Worst headache that I have ever had" What are we looking for in regards to senses any in changes in vision, smell, taste, hearing. Diplopia double vision tinnitus ringing in the ear What are the components of neurological exam Mental status exam; cranial nerves; motor and cerellar function; sensory function; deep tendon reflexes What is included in the mental status exam appearance, behavior, cognitive function (LOC and A&O Explain the Cognitive Function 1. Person (own name, occupation) 2. Place (where lives, present location, city & state) start off narrow then move to broad 3. Time (day of week date, year, season) Narrow --> broad 4. Situation (why are you here) Define A & O Orientation and Alertness / Arousal How do you characterized orientation O X 4 - O X 1 O X 4 oriented to person, place, time and situation O X 3 oriented to person, place, and time O X 2 oriented to person and place O X 1 oriented to person What is the first to be lost in person, place, time, and situation Time Explain Alertness / Arousal respiratory pattern & papillary response What are we checking for with alertness / arousal 1. voice 2. tactile touching 3. Pain a) sternal rub -knuckles b) nail bed pressures to toes / fingers Lethargic aroused by saying their name or touch (drowsy) Obtunded requires more vigorous stimuli to awaken (not at full capacity when awake) Stuporous requires painful stimuli to respond, typically the response will be to withdraw from the pain Semicomatose requires painful stimuli, respond with abnormal flexion or extension Comatose no response to stimuli Name Cranial Nerve I Olfactory ; Sensory What is the function of CN I carries smell impulses from nasal mucous membrane to brain; Odor identification How do you assess CN I close eyes, occlude one nostril & present aromatic substances (coffee, toothpaste, peppermint, soap) Characteristics of CN I decreased smell bilaterally with age What could cause problems for CN I Lesion / tumor, trauma to the nerve ( smoking, cocaine) Name Cranial Nerve II Optic ; Sensory What is the function of CN II carries visual impulses from eye to brain How do you assess CN II test visual acuity (chart 20 / 20) & fields by confrontation; examine optic disc with ophthalmoscope Name Cranial Nerve III Oculomotor / Motor Name Cranial Nerve IV Trochlear / Motor Name Cranial Nerve VI Abducens / Motor What is the function of CN III , IV, & VI contract eye muscles to control eye movements, constrict pupils and elevate eyelids; contracts one eye muscle to control eye movement; controls lateral eye movements How do you assess CN III, IV & VI PERRLA ( Pupils - Equal - Round-Reactive-Light-Accomidation) six cardinal positions of gaze What constricts the pupil light What is Nystagmus back & forth oscillation of the eyes When is nystagmus seen with heavy drinking; disease of the vestibular system, cerebellum or brain stem Name Cranial Nerve V Trigminal / Sensory & Motor What is the function of CN V carries impulses of pain, touch, & temp from the face to the brain; influences clenching and lateral jaw movements (biting & chewing) How do you assess CN V motor test motor function by palpating temporal & masseter muscles as the person clenches the teeth (Strong & symmetrical); How do you assess CN V sensory by lightly touching a cotton wisps to the forehead, cheeks, & chine while the person's eyes are closed; asking the patient to distinguish between sharp / dull sensations & to tell you where they feel the sensation What is Corneal reflex cotton against the eye ball - need to blink When is Corneal Reflex used only if an abnormal facial sensation or movement has been detected Name Cranial Nerve VII Facial / Sensory & Motor What is the function of CN VII contains sensory fibers for taste on the anterior 2/3 of tongue and stimulates secretions form salivary glands & tears from lacrimal glands; supplies the facial muscles & affects facial expressions (Salty & Sweet tastes) How do you assess CN VII for motor asking the person to smile, frown, close eyes tightly(while you try to open them), lift eyebrows, show teeth, and puff cheeks How do you assess CN VII for sensory test only when you suspect facial nerve injury ( taste sense with sugar, salt & lemon juice Name Cranial Nerve VIII Acoustic / Sensory What is the function of CN VIII contains sensory fibers for hearing and balance How do you assess CN VIII Normal & whispered words; Weber using tuning fork; Rinne using tuning fork Describe how to assess CN VIII using normal & whispered words client should hear whispered words from 1-2 feet away Describe how to assess CN VIII by Weber using the tuning fork vibration should be equal in both ears; top of the head (lateral) Describe how to assess CN VIII by Rinne using a tuning fork AC ( air conduction) > BC (Bone conduction) place tuning fork behind the ear until can't hear it anymore then move it in front of the ear canal until can't hear it (time them both) What is an abnormal finding with the Weber test Inner ear - prolonged loud sound / odotoxic What is an abnormal finding with the Rinne test Conductive; hearing loss Name Cranial Nerve IX Glossopharyngeal / Sensory & Motor Name Cranial Nerve X Vagus / Sensory & Motor What is the function of CN IX & X controls taste on posterior third of tongue and gag reflex; Provides secretions to salivary glands & promotes swallowing movements(IX = Bitter & Sour taste) What is the function of CN X Carries sensations from throat, larynx, heart, lungs, bronchi, GI Tract, & abdominal viscera; promotes swallowing talking & production of digestive juices How do you assess CN IX & X for motor by depressing the tongue with a tongue blade while the person says "AHHHHHH" - touch posterior pharyngeal wall with tongue blade & note gag reflex (look at the ulva & see them rise & fall) How do you assess CN IX for sensory posterior 1/3 of the tongue for taste Name Cranial Nerve XI Spinal Accessory / Motor What is the function of CN XI innervates neck muscles that promote movement of the shoulders & head rotation How do you assess CN I have person rotate their head forcibly against resistance to side of the chin(sternomastoid); shrug shoulders against resistance (trapezius); Characteristics of CN I Resistance should be strong & symmetric; weakness or paralysis is abnormal Name Cranial Nerve XII Hypoglossal / Motor What is the function of CN XII innervates tongue muscles that promote the movements of food & talking How do you assess CN XII stick out tongue & note forward thrust in the midline; ask patient to move tongue from side to side; ask person to say "Light, Tight, and Distinct" Cranial Nerves CN I = Olfactory; CN II = Optic; CN III = Oculomotor; CN IV = Trochlear; CN V = Trigeminal; CN VI = Abducens; CN VII = Facial; CN VIII = Acoustic; CN IX = Glossopharyngeal; CN X = Vagus; CN XI = Spinal Accessory; CN XII = Hypoglossal CN I Olfactory (Sensory) CN II Optic (Sensory) CN III Oculomotor(Motor CN IV Trochlear (Motor CN V Trigeminal (Both) CN VI Abducens ( Motor) CN VII (Demo) Facial ( Both ) CN VIII (Demo) Acoustic ( Sensory ) CN IX (Demo) Glossopharyngeal (both) CN X (Demo) Vagus ( Both) CN XI (Demo) Spinal Accessory (Motor) CN XII (Demo) Hypoglossal (Motor) What is the cerebellar function balance & coordination What are we observing in balance and coordination Gait What are some abnormal gaits cerebellar ataxia, parkinsonian gait, scissors gait, spastic hemiparesis, footdrop Describe cerebellar ataxia Wide-based, staggering, unsteady gait; Romberg test if + = client can't stand with feet together; seen with cerebellar diseases / alcohol / drug intoxication Describe Parkinsonian Gait shuffling gait, turns accomplished in very stiff manner; stopped-over posture with flexed hips and knees; typically seen in Parkinson's diseased & drug-induced parkinsonian because of effects on the basal ganglia Describe Scissors Gait stiff, short gait, thighs overlap each other with each step; seen with partial paralysis of the legs Describe spastic hemiparesis flexed arm held close to body while client drags toe of leg or circle it stiffly outward and forward; seen with lesions of the upper motor neurons in the cortical spinal tract, such as occurs in stroke Describe footdrop client lifts foot and knee high with each step, then slaps the foot down hard on the ground; client cannot walk on heels; characteristic of diseases of the lower motor neurons How do you assess the gait walk a straight line heel-to-toe (tandom walking); perform Romberg test (positive if abnormal); a shallow knee bend or hop in place, first on one leg, then the other; walk on toes then heels What is the romberg test feet together with hands at one side with eyes open and then closed Explain Upper Extremity Coordination Rapid alternating movements( look for lack of coordination); Finger-to-Nose test; Finger-to-thumb test Describe the finger to nose test on upper extremity coordination close eyes and stretch out arms. Touch tip of nose with each index finger, alternating hands and increasing speed Describe the finger to thumb test on upper extremity coordination touch each finger to the thumb in rapid sequencing What is a test that is used for lower extremity coordination Heel-to-shin test (supine position heel on opposite knee, run it down the shin to ankle) When is a hand grips (use 2 fingers) used looking for neuro command What are the 2 parts of the sensory system spinothalamic tract & posterior column tract What sensations does the spinothalamic tract control pain, temperature & light touch What sensations does the posterior columns control vibration, position, stereognosis ( feeling of familiar object), graphesthesia ( draw # on palm), Two point Discrimination (eyes closed touch with 1/2 fingers), point location What are the sites to test reflexes triceps, biceps, brachioradialis, patellar, achilles Describe how you test the reflexes compare right & left sides; grade on a 4 point scale 4 + ( 4 point scale for reflexes) very brisk, hyperactive 3 + ( 4 point scale for reflexes) brisker than normal 2 + ( 4 point scale for reflexes) expected response, active 1 + ( 4 point scale for reflexes) diminished, sluggish 0 ( 4 point scale for reflexes) no response What are the age-related variations for infants they have unique reflexes - fan out (when run finger/object on sole of foot) up to a year old What are the age-related variations for children take into consideration motor development ( Describe multiple sclerosis autoimmune disease, debilitating & degenerative, onset between age 20 & 40 Which gender does multiple sclerosis affect most women What are the clinical findings that are associated with multiple sclerosis fatigue, depression, parenthesis, gait instability Describe multiple sclerosis inflammation of meninges that surround the brain and spinal cord; What is the worst type of meningitis bacterial or viral bacterial What are some of the clinical manifestations of meningitis severe headache, fever, malaise, stiff neck & + brudzinski's , Kernig's sign Explain brudzinski's sign have the patient lay in supine, flex up neck and passively flex knees & hips ( + if there is pain) Explain Kernig's sign lay supine, rise hips and extend their knees (+ if ther is pain) What is CVA Cerebrovascular accident Describe CVA a thrombosis, embolism or hemorrhage causes impaired circulation What are the 5 major warning signs of CVA 1. sudden weakness, numbness, or paralysis 2. sudden vision impairment 3. sudden confusion, difficulty speaking or understanding speech (aphasia) 4. sudden severe headache without apparent reason 5. sudden trouble with walking & coordination What are some risk factors for CVA Age - older adults, men greater risk than women, family history, african american, personal history or CVA or heart attack, smoking, diabetes, HTN, atherosclerosis, obesity, high cholesterol, excessive alcohol use, transient ischemic attacks