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Exam 3
Neuro & Stroke
74
Nursing
Undergraduate 2
11/03/2010

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Term
Neuron-
Definition

(nerve cell)-transmits nerve impulses

billions exist - 3/4 in cerebral cortex-

receive info from other neurons by dendrites & axons

Term
axons-
Definition
carry impulses away from cell body of the neuron, each neuron has one axon/ may have numerous dendrites.
Term
Dendrites-
Definition
Carry impulses toward the cell body.
Term
Myelin-
Definition
Term
Myelin-
Definition
white, protein-lipid complex formed by Schwann cells in PNS & by oligodendrites in the CNS which surrounds some axons.
Term
Neuroglial- (glia)
Definition

supportive tissue in CNS

5-10x> then neurons,

divide-most CNS tumors originate in them.

4 types w/ specific functions.

Term

Neuroglial- (glia)

name the types & functions

1-4

Definition

1. Microglia-phagocytotic scavengers of damaged nerve tissue.

2. astrocytes-(star) structure of BBB, provide nutrients to neurons & Build scar tissue w/trauma, nutrients, gases,waste

3. Oligodendrocytes-form myelin

4. Ependymal cells-line brain and spinal cord and help produce CSF.

Term
Schwann Cell-
Definition
Forms the myelin sheath in PNS
Term

neurotransmitters-

Acetylcholine-  What is its action?

Definition
excitation, inhibitory on some of PSN
Term

Neurotransmitter-

Dopamine- What is its action?

Definition
inhibitory effect
Term
Neurotransmitter-
Norepinephrine
Definition
generally excitation, inhibtory effect on postsynaptic neurons
Term
Neurotransmitter-
Serotonin-
Definition
inhibitory effect
Term
Neurotransmitter-
Glutamate
Definition
generally excitation
Term
Neurotransmitter-
GABA
Definition
Inhibitory effect
Term
Neurotransmitter-
Substance P
Definition
Excitation
Term
Neurotransmitter-
Endorphin
Definition
Excitation to systems that inhibit pain
Term
CNS consists of?
Definition
Brain and Spinal Cord
Term
PNS consists of?
Definition
Cranial nerves, Spinal nerves, Autonomic Nervous System
Term
Corpus Collosum Function?
Definition
Allows impulses from one side of the brain to the other
Term
Monroe-Kellie Doctrine
Definition
Blood, Brain tissue and CSF in balance.
Term
2 main arteries that supply blood to the brain are?
Definition
Vertebral and Cerebral
Term
Circle of Willis-
Definition
Vertebral and Cerebral arteries connect to form this.
Term
Blood Brain Barrier-
Definition
Selectively permeable, Does not allow lrg molecules cross. allows- Glucose, O2, Co2- but gets irritable.
Term
Brain does not like?
Definition
CO2 in excess, CO, pathogens, toxins, Extra tissue
Term
Atherisclerosis-
Definition
RBCs damage to walls, made weak, thin via genetics or abnormalities
Term
What happends when toddler holds breath?
Definition
Chemoreceptors in aortic arch of brain- Co2 builds up and causes resp. acidosis, Shuts off, ANS kicks in, Blows off CO2.
Term
CSF- How much in body? How much produced daily?
Definition
150 ccs
500 ccs daily
Term
Brain utilizes glucose for energy.
What does it like the range to be?
Definition
80-120
Term
CCP=MAP - ICP
Definition
CEREBRAL PERFUSION PRESSURE, INTRACRANIAL PRESSURE, MEAN ARTERIAL PRESSURE.
Term
ICP is the result of ?
Definition
BP
Term
CCP-
Definition
Pressure exerted on brain tissue.
Term
Factors that change CSF via BLOOD
Definition
aneurysm, venous stenosis, embolism, HTN, Hypotension, hemorrhage, lytes (na+) Glucose 80-120 <70 dangerous
Term
Changes in CSF- Brain Tumor
Definition
Tumor, viral inf-irritates tissue, trauma, ischemic stroke, Pituitary-GF
Term
Changes in CSF- CSF
Definition
Blockage, inf response, meningitis, viral encephalitis
Term
how many pairs of spinal nerves?
Definition
31
Term
Spinal tracts-
Definition
6 afferent- ascending- Sensory
8 efferent- descending- motor
Term
Plexuses- bundles of nerves
Definition
cervical, brachial, lumbosacral
Term
Spinal decussation- What is it?
Definition
Term
ANS-
autonomic nervous system
Definition
unconscious
connects motor nerves to organs and glands.
Term
SNS-
Definition
Thoracocolumnar- flight or fight, norepinephrine.
Term
PSNS-
Definition
Carniosacral system, acetylcholine, Non stressfull situations
Term
Neuro changes with age?
Definition
myelin decreases, conduction delay, cell degeration, neuron death, pain sensation varies, Proprioception (parietal), pupil response, motor function, muscle tone
Term
GCS- GLASCOW COMA SCALE
Definition
Conscious, language, memory, cranial nerve functioning.
Term
GCS- major head injury = score of?
Definition
< or = 8
Term
GCS- moderate head injury score of?
Definition
9-12
Term
GCS- Minor head injury- score of ?
Definition
13-15
Term
Head Injury concerns?
Definition
C spine ok and eval before turning head! ABCs,nutrition, skin integ, mobility-ADLs,fluid lytes,Incontinence, DVTs, infection pneumonia risk?, UTIs, GI- BM? & GU, Mucous membranes dry?, psychosocial,
Term
Espressive dysphagia is?
Definition
Term
Receptive dysphagia is?
Definition
Term
Dysarthria is?
Definition
Term
Ipsilateral is?
Definition
same side
Term
Contralateral is?
Definition
opposite side
Term
Dolls eyes is?
Definition
CN 2,3, 4, 6 eyes move back to midline + not intact
Term
Flexion postering is?
Definition
focus on arms ! flexed in to body= cerebellum (body space) -decorticate
Term
Extensor postering is?
Definition
focus on arms ! flexed away from body- midbrain - lower down, worse re: spinal nerves -decebriate
Term
bilateral flaccidity is?
Definition
brain stem ! rule out spinal cord injurt before pt is ruled as brain dead.
Term
Hemiplegia is ?
Definition
Term
Diagnostic Assessment used with Neuro?
Definition
CT, PET, SPECT, MRI, MRA, CEREBRAL ANGIOGRAPHY, MYELOGRAPHY, CAROTID FLOW STUDIES, EEG, EMG, LP
Term
ICP- Intracranial pressure
Definition
monitored from lateral ventricles
normal ICP IS 0-15 mm.hg
Monroe Kellie hypothesis- balance depends on which can give. blood and csf are easier, csf is last resort.
Term
What causes increased ICP ?
Definition
cranial insult, tissue edema, comp bld vessels, hypoxia, accumlated CO2, vasodilation, increased blood viscosity with sickle cell and polycythemia.
Term
What would someone look like with Increase ICP ?
Definition
Swollen face, HA, change in Mentation and breathing. pupil change, cushing triad- htn, change resp, bradypnea. Compression of the oculomotor nerve is an early sign of brain hernation. Bradycardia (late sign) loss of sympathetic tone.
Term
Cranial surgery- purposes
Definition
tumor, lower ICP, evacuate clot, stop hemorrhage
Term
Surgical positioning for cranial surg-
Definition
Supratentorial -over eye across temple
Non operative side if lrg lesion is removed
1 pillow
HOB 20-30 degrees
Repos Q 2/ skin
Infratentorial- Back of head
small firm pillow or none
ok turn side to side
LOG ROLL- no flexion of neck
Transphenoid- thru nose (pituitary)
access to sella, less risk for hemorrhage
Increased risk for infection thru oropharynx- take antibiotics
No straw/sneeze, cough
delay toothbrush use
Burr holes -
Term
Pre-Op care for Cranial Surgery
Definition
Rx- anticonvulsants-prevent sz, steroids-reduce swelling,
Mannitol and Lasix- osmotic- keep ICP low
Antibiotics
Foley- I&O
NO coughing/straws,nose blowing, try not to sneeze
Deep breathing
Term
Post op cranial surgery-
Definition
Respirator/vent support
Keep free of infection
Fever raises Met rate-
Neuro signs
Fluid and Electrolyte status
Cope w/ sensory deprivation
Hyperoxygenating with head trauma makes the resp drive shut down- BE CAUTIOUS W/ THIS
assess & monioring are critical
Resp- even slight hypoxemia causes cerebral edema
ET tube when awake, breathing spontaneously and ABGs wnl
Analgesics can alter LOC
Term
Temp regulation w/Cranial surgery
Definition
monitor, tylenol >99.6, use cooling blanket
Increase in temp increases metabolic demands
Term
Fluid and Lytes w/cranial surgery
Definition
has A line, CVP
Monitor- chemistries, wt, I&O,
Na balance can cause inc. cerebral
watch for SIADH- water retention, Hyponatremia
monitor lytes, I&O, SG
Fluid/Na restrict
edema- restrict fluids/Na for some
seroids may cause hyperglycemia
H2recept RX- PPI block histamine responce, prevent ulcers
watch for Diab. Insipidous
check Urine SG 1.010-1.020 norm
Term
Labs with cranial surgery-
Definition
BS, lytes, BUN, NH3, serum and urine OSMO, Ca, PT, PTT, Ketones, ABGs, HH,
Ct scan
Term
Sensory Deprivation-
Definition
Periorbital edema
elev HOB 30 degrees or MD order
Cold compress
Warn pt when we enter room
watch for increasing edema, clot, or increased ICP.
Report neuro changes and observations
Term
Complications from cranial surgery-
Definition
Intracranial bleeding or hematoma
Cerebral edema w manipulation
DVT- bedrest
UTI-foley
Pressure Ulcers-immobility
PE- immobility- DVT moving
Post op seizures-possible may be Rx induced. Dilatin etc.
IV access, side rails up, bed in lowest position, yanker (suction) call bell, stay with them when OOB
Term
SEIZURES TO REPORT - 911
Definition
iF pregnant
> 5min
repeat intractable
injury as result of
LOC changes after sz
occuring in water or submersion
Term
Antecerebral artery affects-
Definition
judgement, insight and reasoning
Term
Paralysis of lateral gaze effect of which CN?
Definition
III
Term
Stimulatin of PNS
Definition
PNS- relaxes urinary sphincters
SNS- sweat, dilated skin blood vessels
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