last damn test before the final

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1

Cranial nerve 1 is called ______________ and is for ______________.

Olfactory

smell

2

Cranial nerve 2 is called ____________ and is for ____________.

Optic

Vision

3

Cranial nerve 3 is called _________________ and is for ___________.

Oculomotor

moving eyes up, down medial

4

Cranial nerve 4 is called __________________ and is for ___________.

Trochlear

Moving eyes down and in

5

Cranial nerve 5 is called ______________ and is for ________________.

Trigeminal

Touch forehead/cheek/clench teeth

6

Cranial nerve 6 is called ______________ and is for ______________.

Abducens

eyes look side to side

7

Cranial nerve 7 is called _________________ and is for ______________.

Facial

Taste for anterior 2/3rds of tongue /smile

8

Cranial nerve 8 is called _____________ and is for ____________.

Acoustic

Hearing and equilibrium

9

Cranial nerve 9 is called ___________________ and is for ______________.

Glossopharyngeal

posterior 1/3 of tongue and speech

10

Cranial nerve 10 is called ____________________ and is for ______________.

Vagus

defication

11

Cranial nerve 11 is called ____________________ and is for ____________.

Spinal accessory

shoulder shrug

12

Cranial nerve 12 is called ________________ and is for ________________.

hypoglossal

tongue movement

13

Peripheral neuropathy can involve what kind of nerves?

Sensory and/or motor nerves

14

When peripheral neuropathy involves one nerve it is known as?

mononeuropathy

15

When peripheral neuropathy involves several nerves it is known as what?

Polyneuropathy

16

List factors that can cause peripheral neuropathy.

Diabetes

Alcohol abuse

Dietary habits

Chronic Renal failure

HIV

Vit-B deficiency

Hypothyroidism

Aging

Arteriosclerosis

17

What medications can cause peripheral neuropathy?

Isoniazid

Hydralazine

Metronidazole

Lithium

Phenytoin

18

How is peripheral neuropathy diagnosed?

Cranial nerve examination

Funduscopic

Lab - antibodies

Electrodiagnostic studies

Biopsy

19

What are the S & S of peripheral neuropathy?

Gradual onset of numbness, prickling, or tingling in feet spreading upwards

Sharp, jabbing, throbbing, freezing, or burning pain

Extreme sensitivity to touch

Lack of coordination and falling

20

What are the first line of treatment drugs for peripheral neuropathy?

Lidoderm patch

Gabapentin

21

What are the second line of treatment drugs for peripheral neuropathy?

Carbamazepine

Phenytoin

22

WHat are non medication treatments for peripheral neuropathy?

physical therapy

assistive devices

safe environment

footwear at all times

foot hygiene

23

How do you prevent peripheral neuropathy?

Manage underlying conditions

Healthy lifestyle choices such as:

Healthy diet/regular exercise

Avoid factors that may cause nerve damage such as:

repetitive motions

cramped positions

exposure to toxic chemicals

smoking and alcohol abuse

24

When doing a rapid neurologic assessment on a patient, what are you going to assess for?

Glasgow coma scale

Response to painful stimuli

Level of consciousness

Decortication

Decerebration

Pupil assessment

25

These two posturing body positions can indicate a brainstem injury.

Decorticate

Decerebrate

26

what are the three things assessed on a Glasgow coma scale?

Eye opening

Verbal response

Motor response

27

What does an electroencephalography show?

Records the electrical activity of the cerebral hemispheres

28

When doing an electroencephalography, what two things can be done to CAUSE a seizure?

Sleep deprivation

Anticonvulsants withheld

29

What is a seizure?

A sudden, abnormal, excessive electrical discharge from the brain. It can change motor and/or autonomic function, consciousness, or sensation.

30

What is an epileptic seizure?

an abnormal excessive amount of neural activity in the brain that originates in the central nervous system.

31

What is a non-epileptic seizure?

a response to stimulus that does not originate in the central nervous system

32

What are the two basic types of seizures?

Partial - Start in a specific part of the brain. Can be simple with no loss of consciousness or complex with loss of consciousness

General - affect the whole brain (Absence/petit mal and tonic -clonic/ grand mal)

33

If a partial seizure becomes generalized, its called a _____________ ______________ seizure.

Secondary generalized

34

What are some signs and symptoms of impending seizure activity?

Smelling burnt toast

Spiders crawling on arms

Odd odors or foul tastes

lip smacking

auras

wringing of hands

35

When referring to seizures, what is Ictus?

The actual seizure activity

36

What is the postictal phase of a seizure?

Post seizure

37

What is typically seen in a simple partial seizure?

Confided to 1 brain lobe

Person is fully aware but unable to control whats happening

May have sudden intense feelings of fear, bliss, or deja vu

May have aura, tingling/ numbness, see flashing lights

Ictus phase usually short, making it difficult to identify true seizure activity

38

If a seizure is happening in the frontal lobe of the brain, what will you see?

Movement of extremity or change in speech

39

If a seizure is happening in the temporal lobe of the brain, what will you see?

Changes in Memory, sound, smell, emotions

40

If a seizure is happening in the occipital lobe of the brain, what will you see?

See flashing lights, fireballs, bright colors shooting across half of visual field

41

What nursing considerations should you take for a person having a partial seizure?

Remember that symptoms can be frightening

Offer reassurance that this will pass

Assess the immediate environment

Remember that a partial can be a warning sign for a stronger seizure

42

What should you expect to see in a person having a complex partial seizure?

Affects entire hemisphere

Person cannot respond and will not remember events

may appear fully awake but with a blank stare

Automatisms - involuntary automatic behaviors such as chewing, lip smacking, hallucinations, odd behavior

Postictal phase may be minimal or nonexistent

Without warning, may fall to ground

43

What nursing management should you do for a patient with a complex partial seizure?

Same as simple partial seizure

If person falls, assess for injury's

Behavior may change if person thinks he's being restrained - DO NOT RESTRAIN

Use calm reassuring voice

If the person gets up and starts walking away be prepared to follow

44

True or False: Generalized non convulsive seizures are know typical absence seizures?

True

45

What are the characteristics of generalized non convulsive seizures?

May stop speaking mid sentence (blank stare)

Repeated lip smacking/eye blinking

Sudden brief lapse of consciousness

Don't remember the event

Frequent but short in duration

Can continue with normal routine after

46

What is another name for generalized non convulsive seizures?

Absence or Petit Mal

47

Characteristics of Atypical absence seizures?

Longer than generalized non convulsive

up to 45 mins

Longer recovery time

LOC not always complete

48

Characteristics of myoclonic seizures?

Sudden brief jerking of muscle groups lasting a few seconds

Affected areas can range from pinky finger to entire torso

Person may report soreness or cramping in affected area

Can affect bowel/bladder control

May lead to a tonic clonic seizure

49

Characteristics of atonic seizures?

Occurs as result of sudden loss of tone in postural muscles

Will drop to ground if standing/slump if in chair

Consciousness will be lost for a split second

Common injuries include ankles, knees, chin (site of impact)

50

Characteristics of generalized convulsive seizures?

Muscle spasm in which arms and legs flex

Alternates between contraction and relaxation (8 spasms per sec)

Can strike without warning

May scream or moan

Breathing could be impaired (May become cyanotic)

May lose bladder/bowel control

Pupils will be dilated

Can appear violent

51

What is another name for Generalized convulsive seizures?

Tonic-clonic//Grand Mal

52

What does the initial tonic phase of a convulsive seizure look like?

Falls, brief flexion of back followed by staring

Arms may be up in air signaling tonic phase is about to start

53

Describe the postictal phase

Will be very still with flaccid muscles

54

Signs and symptoms of tonic to clonic phase

Various alterations in LOC

"Spacing out"

Urinary/fecal incontinence

Brief periods of apnea

55

Nursing management of a generalized seizure

Communicate throughout the episode

Protect the head

Loosen tight clothing

Turn to recovery position

Do not force anything in the mouth

56

Usual causes of status epilepticus

Prolonged seizures lasting more than 5 mins or repeated seizures over the course of 30 mins

Neurologic emergency that must be treated promptly and aggressively

Sudden withdrawal of AEDs, infections, alcohol withdrawal, head trauma, cerebral edema, and metabolic disturbances

57

Treatment of status epilepticus

Establish airway

Administer O2 as needed

IV access

Admit pt to ICU

Give IV diazepam, lorazepam, phenytoin, fosphenytoin, or general anesthesia

58

Seizure precautions:

O2 and suctioning available

Saline lock may be necessary

Side rails up at all times

Padded side rail (use is controversial)

Bed in lowest position

Never put anything in pts mouth

59

Nursing interventions during a seizure

Protect pt from harm

Loosen restrictive clothing

Don't restrain the pt

Turn pt on side to decrease aspiration

Time the seizure

Do not attempt to open jaw

Time seizure

Assess for injury after seizure

Reorient pt

Perform neuro check

60

Pt and Family education about seizures

Antiepileptic drugs may not be stopped even if seizures stop

Refer limited income pts to social services

All states prohibit discrimination against ppl with epilepsy

Wear medalert bracelet at all times

Regular bloodwork to maintain therapeutic levels

Alternative employment may be needed

Vocational rehab may be subsidized

61

What is the use and MOA of carbamazepine?

Used for seizure treatment (simple and complex partial and secondary generalized), bipolar disorder, and trigeminal neuralgia

MOA: Na+ channel blocker, binds inactive Na+ channel, extended inactivation

62

What is the use and MOA of phenytoin?

Used for seizure treatment (simple and complex partial, and secondary generalized).

MOA: Na+ channel blockers with complex action

63

What is the use and MOA of Lamotrigine?

Used for treatment of seizures (all types), bipolar and antidepressants.

MOA: Na+ channel blocker; selective for excitatory neuron NT

64

What is the use and MOA of Ethosuximide?

Used for treatment of seizures (absence seizures).

MOA: Ca2+ channel blocker

65

What is the use and MOA of phenobarbital?

Used for treatment of seizures (simple and complex partial, secondary generalized) and tremors.

MOA: GABA antagonists: augments GABA receptors

66

What is the use and MOA of valproate?

Used for treatment of seizures (all types), bipolar, and migraine prophylaxis.

MOA: many; blocks Na+ and Ca, and enhance GABA

67

What is the use and MOA of Topiramate?

Used for treatment of seizures (all types), and migraine prophylaxis

MOA: many; blocks Na+ and Ca, and enhance GABA

68

What is the use and MOA of Gabapentin?

Used for treatment of seizures (simple and complex partial, secondary generalized), and neuropathic and chronic pain.

MOA: unknown

69

What is the use and MOA of pregabalin?

Used for treatment of seizures (simple and complex partial, secondary generalized), neuropathic pain, and fibromyalgia

MOA: Unknown

70

What is the use and MOA of Levetiracetam?

Used for treatment of seizures (all types).

MOA: Unknown

71
card image

What is this posture and what does it indicate?

Decerebrate Posturing

Indicated by rigid extension of the arms and legs, downward pointing of the toes, and backward arching of the head.

Indicative of deterioration of structures of the nervous system, particularly the upper brain stem.

72
card image

What is this posture and what does it indicate?

Decorticate Posturing

Indicated by rigidity, flexion of the arms to the chest, clenched fists, and extended legs.

Indicative of damage to the corticospinal tract.

73

What are the deep tendon reflexes?

Biceps

Triceps

Brachioradial

Quadriceps

74

What are the superficial reflexes?

Plantar

Abdominal

Babinski

75

What is the reflex scale numbering?

0=absent

1+ = weaker than normal

2+ = normal

3+ = stronger

4+ = hyperactive

76

How is the Glasgow coma scale rated?

E+V+M=total score

77

On the Glasgow coma scale how are the eyes rated?

4=spontaneous

3 = to voice

2 = to pain

1 = none

78

On the Glasgow coma scale how are the verbal responses rated?

5= normal conversations

4= disoriented conversations

3= words but not coherent

2= no words, sounds only

1= nothing

79

On the Glasgow coma scale how are the motor responses rated?

6 = normal

5 = localizes to pain

4 = withdraws to pain

3 = Decorticate Posturing

2 = Decerebrate Posturing

1 = None

80

What is PERRLA?

Pupils Equal in size, Round and regular in shape, Reactive to Light and Accommodation

81

This procedure is when a needle is inserted into the subarachnoid space to measure pressure, obtain CSF for analysis, and inject contrast, anesthetics, and certain medications.

Lumbar puncture

82

What are the nursing interventions for a lumbar puncture?

Verify consent has been signed

Have client empty bladder/bowels

Position client on side with knees to chest and chin tucked

Assist providers wit fluid collection and measuring pressure

83

What post procedure precautions for lumbar puncture should a nurse take?

Encourage fluid intake

Check puncture site for redness, swelling, and clear drainage

Assess movement of extremities

Monitor for complications

84

What are the nursing interventions prior to a CT scan?

Verify consent has been signed

check for allergies to iodine, contrast, dyes or shellfish

Assess BUN and CRE

Instruct client to lie still and flat

85

What are the nursing interventions post CT scan?

Increase fluid intake to clean out dye

assess dye injection site

assess for allergic reaction to dye

86

This in an injection of dye, usually via the femoral artery, to allow visualization of the cerebral arteries.

Cerebral arteriography

87

What are the nursing interventions prior to a cerebral arteriography?

Verify consent has been signed

check for allergies to iodine, contrast dyes, or shellfish

Assess BUN and CRE

Keep client NPO 4-6 hours before

Mark distal peripheral pulses

Instruct client that their face may feel warm during procedure.

88

What are the nursing interventions post procedure for a cerebral arteriography?

Monitor for an altered level of consciousness and sensory or motor deficits

check for bleeding or hematoma at the insertion site. Movement is restricted for 8-12 hours.

Check peripheral pulses, color and temp of extremities

89

What four things characterize Parkinsons?

muscle rigidity

bradykinesia

tremors

postural instability

90

What cause Parkinsons?

Unknown

can be genetic or environmental

91

What are the risk factors for Parkinsons ?

onset between 40-70

more common in men

genetic predisposition

Chronic use of antipsychotic medication

92

What are the expected findings in Parkinsons?

fatigue

decreased manual dexterity

stooped posture

slow, shuffling gait

difficulty chewing or swallowing

drooling

mood swings

93

What nursing care should you give a patient with Parkinsons?

exercise

ambulation

good nutrition

encourage use of assistive devices

teach fall precautions

maintain client mobility as long as possible

provide small frequent meals (high calorie, High Protein)

Promote communications

Monitor mental and cognitive status

94

What medications are used for patients with Parkinsons?

Antivirals

Dopaminergics

Dopamine agonists

Anticholinergics

COMT inhibitors

Monoamine oxidase