Study sets, textbooks, questions
Upgrade to remove ads
Ch. 36 Objectives and other
153 Unit 5 Neuro
Terms in this set (69)
What two anatomic divisions is the nervous system broken up into?
What is the difference between the CNS and PNS?
- CNS for processing, transfer, and storage of information
- PNS for support, nutrition, regulation and protection of neurons
What is the basic structure of the nervous system?
neuron (nerve cell)
transmit impulses TO the CNS
transmitting impulses FROM the CNS
what is a neuron composed of?
- cell body
afferent vs. efferent
- afferent= "to" or "toward"
- efferent= "away from"
Are axons or dendrites larger?
1) What are axons called when they are covered in myelin?
2) what are they called when they aren't covered in myelin?
1) myelinated, white matter, or white nerve fibers
2) unmyelinated, gray matter, or gray nerve fibers
Nodes of Ranvier
gaps in the myelin sheath
the jumping of action potentials from node to node
What 3 parts is the brain devided into?
the cerebrum, the cerebellum, and the brain stem
- part of the brain consisting of two hemispheres connected by the corpus callosun
- area of the brain responsible for all voluntary activities of the body
How many ventricles are in the brain?
- two lateral ventricles
- 3rd, and 4th ventricles
what does the ventricles in the brain manufacture?
cerebrospinal fluid from tissue within the choroid plexus that line the ventricles
Functions of cerebrospinal fluid:
- protects the structures of the brain like a shock absorber
- acts as a barrier to infectious organisms
- toxic metabolites and some drugs that enter the blood
- floats the brain to reduce pressure at its base
- maintains relatively constant intracranial pressure
Once _______ is formed, it is circulated within the subarachnoid space of the 2)_____and______ to openings where it becomes reabsorbed into the _____________.
2) brain and spinal chord
3) venous system
What is the function of the spinal cord?
functions as a passageway for ascending and descending motor neurons.
the sensory fibers enter the 1)_________ portion of the cord, while the nerve fibers that transmit motor impulses run outward to the peripheral nerves from the 2)__________ portion of the cord.
1) posterier (dorsal)
2) anterior (ventral)
Cranial Nerve I:
Olfactory nerve - sense of smell
Cranial Nerve II:
Optic nerve - sight
Cranial Nerve III:
Oculomotor nerve - contraction of iris and eye muscles
Cranial Nerve IV:
trochlear nerve - eye movement
Cranial Nerve V:
trigeminal nerve - sensory nerve to face, chewing
Cranial Nerve VI:
Abducens nerve - eye movement
Cranial Nerve VII:
facial nerve - facial expression, taste, secretions of salivary and lacrimal glands
Cranial Nerve VIII:
vestibulocochlear nerve (or auditory) - hearing and balance
Cranial Nerve IX:
glossopharyngeal nerve - taste, sensory fibers of pharynx and tongue, swallowing, secretions of parotid gland
Cranial Nerve X:
vagus nerve - motor fibers to glands producing digestive enzymes, heart rate, muscles of speech, gastrointestinal motility, respiration, swallowing, coughing, and vomiting reflex
Cranial Nerve XI:
accessory (spinal) nerve - head and shoulder movement
Cranial Nerve XII:
hypoglossal nerve - movement of the tongue
What 2 roots do spinal nerves have?
- dorsal nerve fibers are sensory
- ventral nerve fibers are motor
How many spinal nerves are there?
- 31 pairs
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
What is a dermatome? Why are they useful?
- specific area of skin supplied by a single spinal nerve
- useful for identifying areas affected by certain viral infections such as shingles, anesthetizing localizing areas of the body, and assessing and evaluating spinal injuries
What does the autonomic nervous system consist of and what is its function?
- sympathetic nervous system and parasympathetic nervous system
- maintain homeostasis by stimulating or inhibiting smooth muscles, cardiac muscle, and glands.
What is the sympathetic nervous system? What neurotransmitter is released?
fight or flight
- the division of the autonomic nervous system that responds using a fight or flight response when there is a perceived or actual threat to survival.
- catecholamines such as epinephrine, norepinephrine and dopamine.
- caused by stressful situations such as danger, intense emotions, and severe illness
What is the parasympathetic nervous system? What neurotransmitter is released?
rest and digest
- the division of the autonomic nervous system that works to conserve body energy and is partly responsible for slowing heart rate, digesting food, and eliminating body waste.
- Release of acetylcholine allows passage of a nerve impulse from the nerve fiber to the effector organ or structure, where the enzyme acetylcholinesterase inactivates acetylcholine
What types of medications can affect a neurological assessment?
- opioids and CNS depressants
- temporarily delay until opioid is metabolized
Physical exam: when assessing for bleeding, swelling, or wounds and signs of trauma, the nurse:
Does NOT move or manipulate the client's head during this part of assessment, especially with hx of trauma
Assessment of motor function
- assessing muscle movement, size, tone, strength and coordination
- look for atrophy and assess opposing muscles for equality of size and strength
- push the palm or sole against examiners palm
- pick up small or large objects between the thumb and forefinger
- grasp objects firmly
- resist removal of an object from the fist or fingers
- assess gait and balance, turn abruptly, walk heel to toe
- finger to nose test
motor response in a comatose or unresponsive patient
-painful stimulus appropriate response by patient is to reach toward or withdraw from the stimulus
- impaired cerebral functioning will manifest abnormal posturing
- EX. decorticate posturing, decerebrate posturing (more serious), flaccidity (even more serious)
Assess: olfactory nerve
- ask client to occlude each nostril separately and close the eyes. Present familiar odors (vinegar, coffee, lemon)
- normal findings= client identifies odors
Assess: optic nerve
- help client cover each eye separately. Test visual acuity using a Snellen chart, newspaper or Jaeger chart
- normal findings= client names letters or reads words accurately
Assess: oculomotor nerve (abducens nerve)
- in a darkened room, shine a bright light in each pupil, ask client to look at a near and far object
- normal findings= Pupil constricts briskly in response to light and dilates when looking far away, eye movement is coordinated in all directions
Assess: trochlear nerve
- ask client to follow an object you move in horizontal, vertical, and oblique directions
- normal findings= eyes move inferiorly and medially
Assess: trigeminal nerve
- observe for jaw symmetry while client opens mouth.
- instruct client to clamp jaws tightly together
- stroke forehead, cheeks and jaw with a wisp of cotton, sharp object, cold and warm objects and vibrating tuning fork
- touch each cornea with a wisp of cotton
Touch center of chin with reflex hammer while client slightly opens mouth
- normal findings= appearance is symmetric, the muscles contract bilaterally, client shows bilateral sensitivity and correctly identifies sensory experience, client should blink, jaw should close suddenly
Assess: Abducens nerve
- in a darkened room, shine a bright light in each pupil, ask client to look at a near and far object
- normal findings= client moves eyes in lateral directions
Assess: facial nerve
- ask client to wrinkle the forehead, smile, frown, raise eyebrows, look at the ceiling and whistle
- instruct client to close eyelids and resist examiners efforts to open them
- apply sweet, sour, salty and bitter flavors to both sides of the anterior tongue
- normal findings= facial movements should be symmetrical, both eyes should equally resist efforts to open them, client accurately identifies tastes
Assess: vestibulocochlear nerve
- test hearing acuity and perform the Rinnie and Weber Tests with a tuning fork
- have client stand with both feet close together; note for swaying with eyes open and then shut
- normal findings= Client should be able to repeat whispered words correctly, sound is lateralized equally and heard longer by air than by bone conduction. Client should be able to maintain balance or sway slightly
Assess: glossopharyngeal cranial nerve
- touch palate with tongue blade
- ask client to say "ah"-
- normal findings= blade emits a gag response, Uvula remains midline
Assess: vagus nerve
- ask client to say "la, la, la"
- normal findings= client should speak clearly and distinctly with no hoarseness
Assess: accessory nerve (spinal)
- instruct client to shrug shoulders as you apply resistance
- normal findings= client should be able to raise shoulders
Assess: hypoglossal nerve
- tell client to stick out tongue
- normal findings= tongue should remain midline with no lateral deviation.
Somnolent or lethargic
The client is drowsy or sleepy at inappropriate times but can be aroused, only to fall asleep again. Responses to questions and verbal commands are delayed or inappropriate. Speech is incoherent. Painful stimuli elicit a response.
The client is aroused only by vigorous and repetitive physical, auditory, or visual stimulation. Stimulation results in one or two word answers or in motor activity or purposeful behavior directed toward avoiding further stimulation.
The client is unresponsive except to superficial, relatively mild painful stimuli to which the client makes some purposeful motor response (movement) to avoid further stimulation. Spontaneous motion is uncommon, by the client may groan or mutter.
The client responds only to very painful stimuli by fragmentary, delayed reflex withdrawal; in deeper stages, he or she loses all responsiveness. There is no spontaneous movement and the respiratory rate is irregular.
What is the glasgow coma scale and what normal and abnormal score?
- an objective assessment tool for evaluating the LOC of a client
- normal= 15
- 7 or less = coma
What is the Rancho Los Amigos Scale? why is preferred?
- another tool for assessing LOC. some rehabilitations prefer this because it is a more flexible assessment tool for identifying variations in the clients stantus
Rancho Los Amigos Scale
- level I. No Response: Patient appears to be in a deep sleep and is unresponsive to stimuli.
- level II. Generalized Response: Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Reflexes are limited and often the same, regardless of stimuli presented.
- level III. Localized Response: Patient responses are specific but inconsistent, and are directly related to the type of stimulus presented, such as turning head toward a sound or focusing on a presented object. He may follow simple commands in an inconsistent and delayed manner.
- level IV. Confused-Agitated: Pt in heightened state of activity and severely confused, disoriented, and unaware of present events. Behavior frequently bizarre and inappropriate to immediate environment. Unable to perform self-care. If not physically disabled, may perform automatic motor activities such as sitting, reaching and walking as part of agitated state, but not necessarily as a purposeful act.
- level V. Confused-Inappropriate, Non-Agitated: Pt appears alert and responds to simple commands. More complex commands, however, produce responses that are non-purposeful and random. Pt may show some agitated behavior in response to external stimuli rather than internal confusion. Pt is highly distractible and generally has difficulty in learning new information. Can manage self-care activities with assistance. Memory is impaired and verbalization is often inappropriate.
- level VI. Confused-Appropriate: Pt shows goal-directed behavior, but relies on cueing for direction. Can relearn old skills such as activities of daily living, but memory problems interfere with new learning. Has beginning awareness of self and others.
- level VII. Automatic-Appropriate: Pt goes through daily routine automatically, but is robot-like with appropriate behavior and minimal confusion. Has shallow recall of activities, and superficial awareness of, but lack of insight to, condition. Requires at least minimal supervision because judgment, problem solving, and planning skills are impaired.
- level VIII. Purposeful-Appropriate: Pt alert and oriented, and is able to recall and integrate past and recent events. Can learn new activities and continue in home and living skills, though deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.
neuro assessment: Neck
- assess for stiffness or abnormal position. The presence of rigidity is checked by moving the head and chin toward the chest
- do NOT do if there is a suspected head or neck injury or known trauma
neuro assessment: Vital signs
- monitor BP, pulse, RR and Temp w/ potential or actual neurological disorder
- monitor temp q hrs because CNS disorders can affect the temperature regulating ability of the hypothalamus
- notify physician right away of a change to any vs
neuro diagnostic tests
- CT, MRI, PET, SPECT
- help dx brain tumors, alzheimer's disease, intracranial bleeding or hemorrhage and cerebral infections
- Lumbar puncture
- cerebral angiography
- Brain scan
- Nerve conduction studies
- Spinal tap- used to obtain samples of CSF from the subarachnoid space for laboratory examination and to measure CSF pressure. Bacteriologic tests on specimens reveals the presences of microorganisms
- also performed before injecting a drug into the subarachnoid space to administer a spinal anesthetic to remove CSF to relieve intracranial pressure to inject air, gas or dye for neurological dx test.
- pt positioned on side w/ knees flexed. A local anesthetic is given and spinal needle is inserted. 3 tubes filled with 5-10mls of CSF taken. After procedure apply pressure dressing to site. HOB up slightly for 4-8hours. Monitor LOC, VS, sensation and motor.
Normal vs. abnormal CSF
- normal= clear and colorless with a pressure of 80-170mm H2O
- abnormal= a pressure over 200
side affects r/t lumbar puncture
- post-procedural HA in supine position and head movement w/in 24 hrs up to 14 days after
pt teaching after lumbar puncture
- recline less less than an hour up to several hours after test
- increase fluid intake
- avoid caffeine
- limit activity for 24 hrs
- done to relive clients discomfort following lumbar puncture
- instillation of 20-30mL of client's venous blood into the epidural space to seal the leak of CSF from the diagnostic perforation, or by instilling a similar amount of saline
Electroencephalogram (EEG) Nursing considerations:
- tell the client that he or she will not experience any electrical shock during and that the source of the electrical energy is the clients neural activity in the brain
- withhold sedatives, coffee, tea, and soft drinks that contain caffeine for at least 8 hours before the test to avoid affecting the findings
- allow the client to eat; a low blood glucose level can alter findings
- direct the client to shampoo his or her hair to remove oil and hair products. Clean hair facilitates and promotes maintenance of electrode attachment throughout the test.
- awaken the client around midnight before the EEG to ensure sleep deprivation.
- after= the client who is sleep deprived can rest and have hair shampooed to remove the glue used to affix the electrodes to the scalp.
Sets found in the same folder
Ch. 36 Key Terms
Ch. 40 Learning Objectives and extra notes
Ch. 40 Key terms
37 & 38 Seizures and Cerebrovascular disorders
Other sets by this creator
Respiratory: Class 1
N252 Unit 1: ABG Interpretation
Other Quizlet sets
Ochem lab quiz 1
QUIZ Chapter 5: Government
Unit 3( Ch6-7-8-9)
Abnormal Psych: Anxiety Disorders Exam 2 Review