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505 Ch 16 - Alterations
Alterations in cognitive, cerebral, hemodynamics and motor functions
141
Nursing
Graduate
12/08/2011

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Term
A state of awareness of self, environment and responses that consists of arousal and awareness
Definition
Consciousness
Term
This "state of awakeness" is mediated by the Reticular Activating System
Definition
Arousal
Term
This refers to all cognitive functions that embody knowledge of self, environment and affective states (mood.)
Definition
Awareness
Term
The content of your thought is a component of your ____________
Definition
Awareness
Term
If your mental arousal is altered by a lesion that affects an area, it is a _________ Alteration in Arousal
Definition
Structural
Term
Structural alterations in arousal are based on . . . .
Definition
the location of the lesion (e.g. subdural)
Term
This alteration is arousal is caused by interruptions in the delivery of energy substrates:
Definition
Metabolic
Term
If the delivery of a needed bodily product is interrupted (hypoglycemia, ischemia, hypoxia,) it is what type of arousal alteration?
Definition
Metabolic
Term
Metabolic alterations in arousal might be caused by (3 eg's given.)
Definition
hypoglycemia, ischemia or hypoxia
Term
Bilateral hemisphere damage or suppression (such as hypoxia, hypoglycemia, uremia, toxins, etc . . .) may cause:
Definition
Prolonged state of unconsciousness.
Term
Prolonged states of unconsciousness can be caused when structural or metabolic process working on this brain system.
Definition
Reticular Activating System
Term
While typing note cards, Buck would like to be ingesting this.
Definition
A malty, hopped beverage.
Term
5 elements of a Neurologic Evaluation
Definition
Level of consciousness, Pattern of breathing, Size/reactivity of pupils, Eye position and reflexive responses, Skeletal muscle motor responses
Term
The most critical element of a Neurologic Eval. is
Definition
Level of consciousness
Term
T/F: patterns of breathing are not useful when evaluating levels of consciousness
Definition
F: Many resp. patterns are helpful
Term
Two basic categories of breathing that help determine levels of consciousness are:
Definition
Hemispheric breathing and Brainstem breathing
Term
Cheyne-Stokes respirations are this type of breathing pattern.
Definition
Hemispheric breathing
Term
Agonal breathing, or agonal gasps are this type of breathing pattern.
Definition
Brainstem breathing
Term
Agonal gasps often indicate this event.
Definition
End of life is nearing.
Term
When a person has alternating periods of hyperventilation and apnea, they are exhibiting this type of breathing
Definition
Cheyne-Stokes
Term
A period of apnea immediately after hyperventilation, it would be called
Definition
Cheyne-Stokes breathing
Term
If the client's head is moved and his/her (open) eyes stay centered in the orbital (don't follow some other point,) it is this sign:
Definition
Doll's eye sign
Term
Doll's eye signs may be found when you test for ___________ __________ __________
Definition
Oculocephalic Reflex response
Term
T/F: The Oculovestibular Reflex Test would be conducted by putting a frozen banana in your ear.
Definition
F: that would be ice water
Term
Putting ice water in a patient's ear would test? The test is called the _________ ice water test.
Definition
The Oculovestibular Reflex; Caloric
Term
In the caloric ice water test, normal eye movement would be?
Definition
Conjugate (together) eye movement
Term
T/F: no eye movement during the an Oculovestibular Reflex Test is abnormal
Definition
T: eyes should move in a conjugate manner.
Term
Dysconjugate eye movement means what?
Definition
Eyes don't move in unison
Term
When eyes don't move in unison, it is called?
Definition
Dysconjugate
Term
In a neurological evil., Skeletal Muscle Motor Response can be generally categorized these three ways:
Definition
Purposeful, Inappropriate, Unresponsive
Term
A purposeful skeletal muscle motor response would be . . . . .
Definition
movement in response to a stimuli such as pain
Term
All of the following are signs of diminished consciousness except: A. Grasp Reflex, B. Snout Reflex, C. Patellar Reflex, D. Palmomental Reflex, E. Suck Reflex
Definition
C. Patellar Reflex
Term
T/F: Decorticate refers to patient lying balled-up (fetal) on his side
Definition
F: Decorticate is lying rigid and straight with arms curled up with hands over chest
Term
In the decerebrate position the clients body is _________ and straight, with the arms ____________ and hands ___________
Definition
Rigid, straight, hyperpronated
Term
When all four extremities are in rigid extension, with hyperpronation of forearms and plantar extension of feet, it is called.
Definition
Decerebrate response
Term
If client demonstrates flexion of arms, wrists and fingers with adduction in upper extremities; extension, internal rotation and plantar flexion in lower extremities, it is this sign:
Definition
Decorticate
Term
T/F: Decorticate and Decerebrate responses often indicate CNS damage at the thoracic level.
Definition
F: these indicate neurologic damage in the brain
Term
Confusion, Disorientation, Lethargy, Obtundation, Stupor and Coma are all levels of _________ Coma
Definition
Acute
Term
When a patient falls asleep easily and is minimally responsive, he/she is demonstrating?
Definition
Obtundation
Term
T/F: Obtundation is when a gravida begins to "show"
Definition
F: it is when a patient with potential neuorlogic disorders falls asleep easily and show minimal responsiveness
Term
T/F: When in a stupor, light stimuli will cause arousal.
Definition
F: repetitive stimuli only
Term
T/F: When lethargic, light stimuli will cause arousal.
Definition
T: Think how most of us feel after a patho lecture, a little stimuli and we're back-in-the-game!
Term
Brain (brainstem) Death has No/Some chance for recovery
Definition
None. The stem maintains internal homeostasis and all lower functions. Without medical intervention, death will occur
Term
T/F: Brainstem death is reversible with time
Definition
F: The stem maintains internal homeostasis and all lower functions. Without medical intervention, death will occur
Term
If brain damage has occurred and patient has no ability to maintain homeostasis, it is likely that this has occurred.
Definition
Brain/brainstem Death
Term
Criteria for labeling brain/stem death include: (6)
Definition
Complete all appropriate therapeutic procedures; client is in unresponsive coma; no spontaneous respirations; no cephalic reflexes; isoelectric EEG; all indications persist through 1 and 6 hours after coma and apnea onset
Term
A brain dead patient's lack of spontaneous respirations is called _______?
Definition
Apnea
Term
The two cephalic reflexes we look for in a potentially brain death patient.
Definition
Ocular and Caloric
Term
Irreversible coma that does not involve the brainstem but still demonstrates homeostasis:
Definition
Cerebral Death
Term
T/F: In cerebral death, the cerebellum is affected
Definition
F:
Term
T/F: Cerebral death results in an irreversible coma
Definition
T:
Term
______________ can continue in Cerebral Death/coma, allowing for continued breathing, temp., cardio and GI functions.
Definition
Homeostasis
Term
If a patient remains in a coma or emerges into a vegetative state, they have this type of CNS death:
Definition
Cerebral Death
Term
A wakeful, but unconscious state is called:
Definition
Vegetative
Term
After emerging to a vegetative state, a patient might progress to a minimally conscious state where they will _________ ________ ________.
Definition
Follow simple commands
Term
After an injury to the pons, the client has intact thoughts and level of arousal, but no efferent pathways; they are __________ in.
Definition
Locked
Term
When a patient is locked in, they might communicate through ______ ___ movements.
Definition
Vertical eye
Term
T/F: A locked in patient cannot feel anything.
Definition
F: their senses function, but they have not efferent (exit) pathways. Cognitive functions are in tact: Hell on Earth!
Term
An abrupt, explosive, disorderly discharge of cerebral neurons results in a _________?
Definition
Seizure
Term
T/F: A seizure has a sudden transient alteration of brain function
Definition
T:
Term
Jerky, tonic-clonic movements during a seizure are called?
Definition
Convulsions
Term
Seizures occur where there is a disruption in the balance of __________ and __________, possibly from a membrane defect leading to unstable resting membrane potentials and conductance issues
Definition
excitation and inhibition
Term
The second most common neurologic disorder is ___________ disorders
Definition
Seizure
Term
T/F: Epilepsy is synonymous with seizures?
Definition
F: Epilepsy is a general term for a primary condition that causes seizures
Term
T/F: Epilepsy has no underlying correctable cause, and affects 5-10% of Americans
Definition
F: there is NO UNDERLYING CAUSE, but only affects 5-10/1000 Americans
Term
Seizure syndromes are classified in 3 ways: __________ arise spontaneously w/o known cause & may be genetic; ____________ have identifiable causes; and ___________ which are provoked (caused,) but the etiology is unknown.
Definition
Idiopathic; Symptomatic (the cause is provoked and known); Cryptogenic (cause unknown)
Term
The disease states of cerebral lesions, biochemical disorders, and cerebral trauma may lead to this abrupt, explosive neural discharge event:
Definition
Seizure
Term
These acute conditions might lead to a seizure: (3)
Definition
infection, brain tumor, fever
Term
T/F: Drugs, and/or drug withdrawal never contribute to seizures
Definition
F: Buck must have caffeine though that's not why he foams at mouth . . . .
Term
Hypoglycemia, fatigue, sleep deprivation, stimulants, antidepressant-drug-withdrawal, environ. stimuli, and menses all can cause _________?
Definition
You guessed it, seizures!
Term
The type of seizure where consciousness is always impaired
Definition
Generalized - about 30% of seizures.
Term
A partial (focal) seizure victim usually retains _______________
Definition
Consciousness
Term
A partial (focal) seizure is also know as a __________ seizure.
Definition
Jackson Ian
Term
Secondary generalization in a seizure is when . . .
Definition
a partial seizure becomes a generalized seizure
Term
A continuous seizure that occurs for > 5 minutes is called . . .
Definition
Status epilepticus
Term
Status epilepticus is very/minimally severe?
Definition
Very - it is a medical emergency because of the resulting cerebral hypoxia. It can result in mental retardation, dementia, other brain damage and/or death.
Term
Phases of seizure (3)
Definition
Tonic, Clonic, Postictal
Term
Seizure phase where muscle contraction w/ increased muscle tone occurs. It is associated with loss of consciousness.
Definition
Tonic Phase
Term
T/F: In the Tonic phase of a seizure, one remains conscious and flaccid
Definition
F:
Term
Seizure phase with alternating muscle contraction and relaxation.
Definition
Clonic Phase
Term
Seizure phase immediately following the contractions: immediately following the main symptoms.
Definition
Postictal State
Term
The Postictal State in a seizure describes?
Definition
The period immediately after the seizure.
Term
T/F: An auricle is a partial seizure that immediately precedes the onset of a more generalized seizure.
Definition
F: Aura
Term
An early manifestation of a seizure that may present days to hours before a seizure is called?
Definition
Prodroma
Term
Prodroma, warnings of a potentially impending seizure, may manifest as?
Definition
Headaches and/or malaise
Term
A data processing defect where pattern recognition and inability to recognize from and nature of objects is know as?
Definition
Agnosia
Term
Agnostics demonstrate?
Definition
A claimed lack of knowledge to the origins of the universe and fondness for exquisite beer.
Term
T/F: Agnosia is a tactile deficit
Definition
F: it can be tactile, visual, and auditory
Term
A loss of comprehension or production of language is called?
Definition
Aphasia
Term
T/F: a complete loss of language comprehension or production is Dysphasia
Definition
F: Dysphasia is an IMPAIRMENT of language capabilities
Term
When one understands words but cannot express them, it is ________
Definition
Expressive Disphasia
Term
Expressive dysphasia indicates an issue in this part of the brain
Definition
Broca's Area
Term
Receptive dysphasia, aka Wernicke's dysphasia, results in?
Definition
Fluent speech but hears others speaking gibberish AND output is nonsense
Term
T/F: Dysphasias are commonly the result of CVA's
Definition
T
Term
An acquired mental disorder that results in attention, coherent-thought and action deficits
Definition
Acute Confusion
Term
Drugs, alcohol, metabolic disorders, CNS/PNS diseases, fever, systemic diseases (heart failure,) head injury or anesthesia can all cause:
Definition
Acute Confusion
Term
This is a type of acute confusion (often mistaken for dementia)
Definition
Delirium
Term
T/F: Dementia is typically rapid in onset.
Definition
F: Usually it has a progressive onset.
Term
The most common cognitive deficit of dementia is?
Definition
Memory Loss
Term
T/F: Dementia is not caused by an impaired level of consciousness
Definition
T:
Term
The most common dementia in older adults, affecting 5 million yearly, is?
Definition
Alzheimer Disease
Term
Several forms of Alzheimer's exist in relation to onset: the hereditary form has this onset:
Definition
early or late onset
Term
Nonhereditary Alzheimer's has this onset:
Definition
sporadic or late onset
Term
If an older adult demonstrates forgetfulness, lack of concentration, decline in abstract thought and problem solving, and loss of judgment, this may be the cause:
Definition
Alzheimer Disease
Term
All of the following are found in the brain tissue of Alzheimer Disease victims, except: a. Amyloid beta peptides, b. Senile plaques, c. Neurofibrillary tangles, d. Necrotic Bowman's capsules
Definition
d. Necrotic Bowman's capsules
Term
T/F: increase intracranial pressure can cause acute confusion
Definition
T:
Term
The normal intracranial pressure, 5-15 mmHg, can be increased by? (4)
Definition
tumors, edema, excessive CSF, or hemorrhage
Term
Increased intracranial pressure changes cerebral dynamics by altering:
Definition
blood volume and flow and tissue perfusion
Term
An increase in fluid in brain tissue is?
Definition
Cerebral Edema
Term
Cerebral edema can occur with? (7)
Definition
Trauma, infection, hemorrhage, tumor, ischemia, infarct or hypoxia
Term
T/F: A cerebral edema can cause a hernia
Definition
T: it can displace blood vessels and tissue
Term
Excess fluid in the cranial vault, subarachnoid space or both, is called?
Definition
Hydrocephalus
Term
Hydrocephalus is also referred to more generally as?
Definition
Water on the Brain
Term
A child with an enlarged head caused by excess fluid has?
Definition
Hydrocephalus
Term
Alterations in Cerebral Spinal Fluid that may cause Hydrocephalus:
Definition
Decreased reabsorption, increased production, blockage of ventricles
Term
An obstruction within the ventricular system of the brain that results in hydrocephalus is called?
Definition
Noncommunicating
Term
The blockage resulting in noncommunicating hydrocephalus may be caused by?
Definition
a congenital problem, lesion or tumor mass
Term
Communicating hydrocephalus is caused by?
Definition
Impaired absorption
Term
Communicating hydrocephalus results from?
Definition
Developmental malformation, head injury, cancer, and/or subarchnoid hemorrhage
Term
Communicating hydrocephalus is also called
Definition
Normal pressure hydrocephalus
Term
Hydrocephalus can be treated with? (2)
Definition
Shunt or Ventriculostomy
Term
Hyper- and hypo- tonia would describe what in muscle mass?
Definition
Increase and decrease, respectively.
Term
T/F: Flaccid muscles would likely be called hypertonia.
Definition
F: hypo-
Term
Increased muscle tone, spasticity, rigidity and cogwheel motion (intermittent jerky motions through range of overall motion) would indicate ______-tonia.
Definition
Hyper-
Term
Paresis is weakness but "plegia" is?
Definition
Paralysis
Term
Weakness of upper and lower body on one side is?
Definition
Hemiparesis
Term
When one is paralyzed in the lower extremities only, it's called?
Definition
Paraplegia
Term
Paralysis of all extremities is?
Definition
Quadriplegia
Term
T/F: Paraplegia retains some muscle tone and may have incomplete loss of muscle power
Definition
T:
Term
A movement alteration w/ excessive movement, chorea, wandering, resting tremors and postural tremors is called?
Definition
Hyperkinesia
Term
Chorea hyperkinesis is often seen in what disease?
Definition
Huntington's
Term
Paroxysmal dyskinesia & Tardive dyskinesia are both types of this alteration in movement
Definition
Hyperkinesia
Term
Abnormal involuntary movement or spasms are seen in this dyskinesia:
Definition
Paroxysmal
Term
Involuntary facial, trunk and extremity movement are caused by this dyskinesia:
Definition
Tardive
Term
T/F: Huntington's is a sex-linked recessive disease affecting children.
Definition
F: It is autosomal dominant and usually manifests when adults are early middle aged (often after they've already passed on the gene to their children.)
Term
This neurotransmitter is depleted in Huntington's victims
Definition
GABA - gamma-amino butyric acid
Term
T/F: Huntington's patients demonstrate choreiform movements, improved coordination and disrupted thought process.
Definition
F: coordination is progressively diminished.
Term
A common degenerative disorder of the basal ganglia involving dopamine is?
Definition
Parkinson's Disease
Term
The dopamine pathway in Parkinson's is affected by reduction of?
Definition
dopaminergic neurons
Term
If a patient had resting tremors, muscle stiffness/rigidity, bradykinesia/slowness, impaired balance, dysarthria/dif. speech, and dysphagia, he would likely have this disease:
Definition
Parkinson's Disease
Term
This famous actor has Parkinson's and is a strong advocate for research into the disease.
Definition
Michael J. Fox.
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