Term
| What is the basic functional unit of the nervous system? |
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Definition
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Term
| _________ provides synapses between two neurons. |
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Definition
|
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Term
| What are the important neurotransmitters? |
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Definition
• Acetylcholine
• Serotonin
• Dopamine
• Norepinephrine |
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Term
| What do neurotransmitters do? |
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Definition
• Communicate messages from one neuron to another
• Multiple neurotransmitters can work at one time to potentiate, modulate or terminate a specific action |
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Term
| What are the 3 gross areas of the brain? |
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Definition
1.) Cerebrum
2.) Brain Stem
3.) Cerebellum |
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Term
| What is the cerebrum associated with? |
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Definition
| is the largest part of the human brain, associated with higher brain function such as thought and action. |
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Term
| What are the lobes of the cerebrum? |
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Definition
| the frontal lobe, parietal lobe, occipital lobe, and temporal lobe. |
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Term
| What do the lobes of the cerebrum control? |
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Definition
| complex problem-solving; value judgements; language; emotions; interpretation of visual images; and interpretation of touch, pressure, temperature, and position sense. |
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Term
| What are the parts of the brain stem? |
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Definition
| medulla oblongata, pons, and midbrain. |
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Term
| What is the brain stem responsible for? |
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Definition
automatic functions including heart rate, breathing and swallowing.
Contains motor and sensory pathways. |
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Term
| What is the cerebellum responsible for? |
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Definition
| coordination of all movement including fine movement and balance. Contains motor and sensory pathways. |
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Term
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Definition
| produced in the lateral ventricles and circulates around the brain and spinal cord through the ventricular system |
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Term
| What is the pathway of cerebral perfusion? |
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Definition
| • Two internal carotid arteries and two vertebral arteries and their extensive system of branches provide blood supply to the brain |
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Term
| What is the protective liquid barrier of the brain that keeps certain things out of brain circulation? |
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Definition
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Term
| What does a vasospasm in the cerebral artery lead to? |
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Definition
| diminished blood flow causing damage to neurons. This can result in a ischemic stroke |
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Term
| What provides collateral circulation in the brain? |
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Definition
| • Arteries around the circle of Willis |
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Term
| What is the venous system of the brain? |
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Definition
• Smaller veins flow into larger veins and then empty into the dural sinuses.
• Network of sinuses empties into the internal jugular vein.
• Have no valves and depend on gravity and pressure. |
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Term
| What regulates the autonomic nervous system? |
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Definition
| centers in the spinal cord, brainstem, and hypothalmus |
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Term
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Definition
| • Regulates activities of internal organs such as the heart, lungs, blood vessels, digestive organs, and glands |
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Term
| What are the 2 divisions of the ANS? |
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Definition
1.) Sympathetic
2.) Parasympathetic |
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Term
| What is the sympathetic nervous system? |
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Definition
| Predominantly excitatory responses (“fight or flight”). Mediated by norepinephrine |
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Term
| What is the parasympathetic nervous system? |
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Definition
| o Parasympathetic nervous system: Controls mostly visceral functions (“rest and digest”). Mediated by acetylcholine |
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Term
| What effect do adrenergic agonists have on the body? |
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Definition
| Pupils dilate, bronchioles dilate, heart rate increased, blood vessels constrict, stomach slows, bladder/uterus relaxes, |
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Term
| What neurotransmitters do adrenergic agonists mimic? |
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Definition
|
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Term
| What are the 4 main adrenergic agonists? |
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Definition
| • Alpha1, Alpha2, Beta1 and Beta2 |
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Term
| What is Alpha 1's main effect? |
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Definition
|
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Term
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Definition
| • Increases cardiac contractility (allows emptying and filling better), vasoconstriction, increase blood return to heart |
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Term
| What is an example of an Alpha 1? |
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Definition
| Phenylephrine used a pressor agent. Alpha1 increase the workload of the heart, increases oxygen demand, if not available can cause chest pain. Can cause headaches, excitability, restlessness. |
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Term
| What is the MAIN effect of Alpha 2? |
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Definition
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Term
|
Definition
• Inhibits norepinephrine (raises BP) release
• Promote vasodilation and decreased BP
• Inhibits Insulin Release
• Decrease GI motility and tone |
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|
Term
| What are examples of Alpha 2? |
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Definition
|
|
Term
| What is Beta 1's MAIN effect? |
|
Definition
|
|
Term
|
Definition
• Increases cardiac contractility, increase C.O. (CHF patients)
• Increases Heart rate
• Increases renin secretion, BP |
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|
Term
| What's an example of a Beta 1? |
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Definition
|
|
Term
| What is Beta 2's MAIN effect? |
|
Definition
|
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Term
|
Definition
• Relax smooth muscles of lungs leading to bronchodilation
• Increase blood flow to skeletal muscles
• Decrease GI motility |
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Term
| What are some examples of Beta 2? |
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Definition
o Short-acting albuterol
o Long-acting salmeterol |
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Term
| What is the major complication of Beta 2? |
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Definition
| cardiac arrhythmias due to increase oxygen demand. Side effects can also be shakiness and cramping of hands, feet, and legs. |
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Term
| What is a direct acting adrenergic agonist? |
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Definition
| o directly stimulate adrenergic receptor |
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Term
| What is an example of a direct acting AA? |
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Definition
| • Epinephrine, norepinephrine |
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Term
| Why should you not give epi orally? |
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Definition
| bc is rapidly metabolized in the GI tract and liver, resulting in unstable serum levels. Usually given SQ & IV |
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Term
| What is an indirect adrenergic agonist? |
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Definition
| stimulate release of norepinephrine |
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Term
| What is an example of an indirect adrenergic agonist? |
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Definition
|
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Term
| What are mixed acting adrenergic agonists? |
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Definition
| stimulate adrenergic receptors & release of norepinephrine |
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Term
| What are examples of mixed acting AA? |
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Definition
• Ephedrine
• Increases HR and BP
• Not as potent as epi |
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Term
| What does epinephrine do? |
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Definition
| • Stimulates alpha (1) and beta (1) receptors (alpha receptors at high doses; beta- 1 and beta- 2 receptors at moderate doses) within the sympathetic nervous system. |
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Term
| What forms does epinephrine come in? |
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Definition
-Epinephrine injection
-Epipen for anaphylaxis
-Racepinephrine (aerosol) |
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|
Term
What do you need to check for before administering?
-Dobutamine
-Dopamine
-Epinephrine
-Norepinephrine
-Ephedrine
-Phenylephrine |
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Definition
|
|
Term
| What is the action of dobutamine? |
|
Definition
| ncrease cardiac output due to decreased contractility |
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Term
| What is the action of dopamine? |
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Definition
|
|
Term
| What is the action of norepinephrine? |
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Definition
|
|
Term
| What is the action of ephedrine? |
|
Definition
| o hypotension mostly from spinal anesthesia |
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Term
| What is the action of phenylephrine? |
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Definition
| hypotension and nasal decongestant |
|
|
Term
What are the nursing actions for:
Dobutamine
-Dopamine
-Epinephrine
-Norepinephrine
-Ephedrine
-Phenylephrine? |
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Definition
| o include frequency of monitoring BP, cardiac rate and rhythm, always put drip on an IV pump, monitor urine output, and monitor IV site for extravasation. |
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Term
| What is an alpha blocker? |
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Definition
| • Alpha blocking are selective (block alpha1) or non selective (blocks alpha 1 & 2) |
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Term
| What do alpha blockers do? |
|
Definition
o Useful in benign prostatic hypertrophy (flomax)
o Can be used in Raynaud’s disease due vasodilating properties
o Can be used for hypertension Cardura, and prazosin (Minipress) |
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Term
| What can alpha blockers/beta blockers cause? |
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Definition
| o Can cause orthostatic hypotension and reflex tachycardia |
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Term
|
Definition
| class of drugs that works by blocking the neurotransmitters norepinephrine and epinephrine from binding to receptors |
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|
Term
| What do beta blockers do? |
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Definition
| • Decrease heart rate, decrease BP, and cause bronchoconstriction (especially when non-selective beta-blockers are administered to asthmatic patients) |
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|
Term
| What can cause SOB in asthmatics? |
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Definition
| • Beta blockers that block β2 receptors |
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|
Term
| What does Beta 1 work on? |
|
Definition
|
|
Term
| What does Beta 2 work on? |
|
Definition
| • Lungs, GI, liver, uterus, vascular smooth muscle |
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|
Term
| What does Beta 3 work on? |
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Definition
|
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Term
| What teaching is necessary for Adrenergic Blockers? |
|
Definition
o Check vital signs. Note if dizziness or lightheadedness occurs; these are often indications of a decrease in blood pressure.
o Do not abruptly discontinue the adrenergic blocker because rebound hypertension could result
o Rise slowly from sitting position to avoid orthostatic hypotension, especially when the drug is first started. |
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|
Term
| What do cholinergic agents do? |
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Definition
| • Stimulate the parasympathetic nervous system |
|
|
Term
| What are the types of cholinergic agents? |
|
Definition
|
|
Term
| What is a direct cholinergic agent? |
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Definition
o Direct Acting
• Urecholine stimulates parasympathetic receptors to increase bladder tone, stimulates contraction and micturition
• Pilocarpine constricts pupils of eyes and promotes drainage of aqueous fluid to treat glaucoma |
|
|
Term
| What is an indirect acting cholinergic agent? |
|
Definition
• Primary use is to treat myasthenia gravis to increase muscle strength
• Prostigmin, Mestinon |
|
|
Term
| What do cholinergic blockers do? |
|
Definition
• Inhibits the action of acetylcholine
• Actions:
o Increases heart rate
o Decreases GI motility
o Urinary retention
o Dilates pupils
o Decreases salivation, bronchial secretions
o Dilates bronchi |
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|
Term
| What are the most common cholinergic blockers? |
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Definition
|
|
Term
| What is important to note about atropine? |
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Definition
| o Atropine has a short half life (IV onset immediate and peaks in 2-4 min), increases HR by blocking vagus stimulation, promotes dilation of pupils by paralyzing the iris sphincter. |
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Term
| What happens if you take atropine with urecholine? |
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Definition
| o Atropine sulfate is an anticholinergic agent, and Urecholine (bethanechol chloride) is a cholinergic agent. If these drugs are taken together, they counteract each other’s action. |
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Term
|
Definition
| patch for motion sickness |
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|
Term
| What teaching is involved with pilocarpine? |
|
Definition
• Correct method of instillation of eyedrops.
• Vision may be blurred after instillation of eyedrops; driving a car or operating machinery should be delayed until vision is clear.
• Withhold eyedrops if symptoms of irritation occur. Report immediately to the health care provider.
• Keep follow-up appointments.
• Atropine-like drugs are contraindicated if the client has glaucoma. These agents cause pupil dilation, decreasing aqueous fluid flow through the canal of Schlemm. Important to obtain history preoperatively |
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Term
|
Definition
o Uses a narrow X-ray beam to scan the body part in successive layers
o Combines radiology and computer analysis of tissue density (with contrast dye)
o Doesn’t show blood vessels well |
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|
Term
| Why is a CT used before an MRI in emergencies? |
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Definition
| o Faster than MRI so that’s why its used in emergencies |
|
|
Term
| What are the main uses of a CT? |
|
Definition
Contusion
Calcification, Atrophy, Inflammation
Space occupying lesions (tumors, edema, abscesses)
Infarcts, blood clots, hemorrhage |
|
|
Term
| What do you need to check before a CT? |
|
Definition
| Allergies, Labs to evaluate renal function |
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|
Term
|
Definition
| • Positron emission tomography (PET): A nuclear imaging technique that produces images of actual organ functioning |
|
|
Term
| What does a PET scan show? |
|
Definition
o Measures blood flow, tissue composition, metabolism
o Brain uses 80% of glucose consumed
o Metabolic changes in Alzheimers
o Tumors
o Biochemical abnormalities |
|
|
Term
| What is the pt teaching for a PET scan? |
|
Definition
Contrast – may taste bad, may get warm and flushed
Sensations
Relax, lie still |
|
|
Term
|
Definition
o Uses radionuclides and instruments to detect single photons, and captures a moment of cerebral blood flow
o Perfusion study, injection of radionuclide |
|
|
Term
|
Definition
o Uses a magnetic field to obtain images of different areas of the body
o With or without contrast agent
o Better for non-acute due to duration of ≈ one hour
o MRA allows visualization of cerebral vasculature |
|
|
Term
|
Definition
| • Cerebral angiography (CTA): An x-ray study of the cerebral circulation |
|
|
Term
|
Definition
| • Myelogram: An X-ray of the spinal subarachnoid space |
|
|
Term
| What is a non invasive carotid flow study? |
|
Definition
| : Use ultrasound to evaluate carotid and deep orbital circulation |
|
|
Term
|
Definition
| • Electroencephalogram (EEG): Represents a record of the electrical activity generated in the brain |
|
|
Term
|
Definition
| • Electromyogram (EMG): Uses needle electrodes to measure changes in the electrical potential of the muscles and the nerves leading to them |
|
|
Term
| What is a lumbar puncture? |
|
Definition
| • CSF is sent to lab for analyze for blood, bacteria, cell count, glucose, protein, and culture. |
|
|
Term
| What does normal CSF show? |
|
Definition
• Normal results should be clear and colorless
o Antibodies and DNA of common viruses: None
o Bacteria: No bacteria grows in a lab culture
o Cancerous cells: No cancerous cells present
o Cell count: less than 5 white blood cells (all mononuclear) and 0 red blood cells
o Chloride: 110 to 125 mEq/L
o Fungus: None
o Glucose: 50 to 80 mg/dL(or greater than two-thirds of blood sugar level)
o Glutamine: 6 to 15 mg/dL
o Lactate dehydrogenase: less than 2.0 to 7.2 U/mL
o Oligoclonal bands: 0 or 1 bands that are not present in a matched serum sample
o Protein: 15 to 60 mg/dL |
|
|
Term
| What are the steps prior to a lumbar puncture? |
|
Definition
o Explain procedure, consent required
o Local anesthetic used
o Patient may be instructed to lie flat after to avoid headache
o Monitor for any neurologic deficits
o Monitor puncture site for signs/sx of infection
o Antibiotics can be administered intrathecally (spinal canal) |
|
|
Term
| What are the severe complications of a lumbar puncture? |
|
Definition
| o ICP is decreased due to withdrawal of fluid, brain can herniate downward, spinal abscess, spinal hematoma, spinal epidural headache, meningitis |
|
|
Term
| What are the less severe complications of a lumbar puncture? |
|
Definition
| temporary voiding problems, low grade temp, backache or spasm, and stiffness in neck |
|
|
Term
| Where is fluid taken from in a lumbar puncture? |
|
Definition
|
|
Term
• Which of the following neurological functions is the primary domain of the cerebellum?
o Visual recognition
o Judgment
o Regulation of emotions
o Maintenance of balance |
|
Definition
|
|
Term
| • What assessment findings would be expected in a client who has stimulation of the sympathetic nervous system or who uses sympathomimetic (adrenergic) drugs? |
|
Definition
| o Pupil and bronchial dilation, increased heart rate, constricted blood vessels, constriction of the GI tract muscles and bladder, and relaxation of the uterus |
|
|
Term
| • When would alpha1-adrenergic agonists be ordered? |
|
Definition
| o To treat hypotension, to increase the force of heart contractions |
|
|
Term
| • What assessment findings would you see in this patient before you give medication? |
|
Definition
| o Decreased blood pressure and possible reflex tachycardia |
|
|
Term
| • When would alpha2-adrenergic agonists be used? |
|
Definition
| o To decrease blood pressure and to decrease GI motility and tone. |
|
|
Term
| • When would beta1-adrenergic agonists be used? |
|
Definition
| o To increase heart rate and force of contraction; to increase renin, which increases blood pressure. |
|
|
Term
| • When would beta2-adrenergic agonists be used? |
|
Definition
| o To dilate bronchioles; to promote GI and uterine relaxation; to increase blood sugar through glycogenolysis; and to increase blood flow to skeletal muscle. |
|
|
Term
| What is considered when performing a CT? |
|
Definition
| o Consent, Allergies, Metformin, Lie Still |
|
|
Term
| What is considered with an MRI? |
|
Definition
o NO METAL
o Loud, lay still |
|
|
Term
| What is considered with an EEG? |
|
Definition
| o No sedatives, sleep deprived, don’t take your seizure medicine |
|
|
Term
| What position is the person in for a lumbar puncture? |
|
Definition
| fetal position (knees up) or lean over the bed side table |
|
|
Term
| What is normal in a lumbar puncture? |
|
Definition
| Clear, glucose, no blood, check for bacteria, WBC |
|
|
Term
| What do you do for head ache associated w/ lumbar puncture? |
|
Definition
| pain med, increase fluids, Lay flat, headache later so give pain meds, give blood patch if HA doesn’t go away |
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