Study Guide Neurotransmitters 1. Communicate messages from one neuron to another 2.

Can potentiate, terminate, or modulate a specific action/excite/or inhibit target cells 3. Example in nursing: SSRIs are drugs that increase the neurotransmitter serotonin in the synaptic cleft, therefore increasing the number available to the target cell. The Brain Cerebrum: 1.Frontal: abstract thought, information storage or memory, motor function, affect, judgment, personality 2. Parietal: sensory, interpretation of information for body position in space, orientation 3. Temporal: understand language and sound 4. Occipital: visual and memory Brain stem: 1. sensory and motor pathways, relay station between PNS and CNS 2. respirations are primary concern with injury to brain stem 3. other functions: alertness, arousal, BP, digestion, HR, (notice: these are autonomic functions) Peripheral Nervous System (includes cranial and spinal nerves) 1. Autonomic system: regulates internal organ activity via sympathetic(fight or flight) and parasympathetic (rest and digest) 2. Somatic system: nerves that connect skin, sensory organs, and skeletal muscles Cranial Nerves Cranial Nerve Type Function 1 Olfactory 2 Optic 3 Oculomotor 4 Trochlear 5 Trigeminal 6 Abducens 7 Facial 8 Acoustic/ Vestibulocochlear 9 Glossopharyngeal 10 vagus 11 Spinal Accessory 12 hypoglossal sensory sensory motor motor mixed motor mixed sensory mixed mixed motor motor sense of smell visual acuity and visual fields Muscles that move the eye, pupillary constriction, lens accommodation muscles that move the eye facial information from touch/pain, chewing muscles that move the eye facial expression and movement, salivation/tearing, taste, hearing hearing and equilibrium taste, sensation in pharynx, tongue and swallowing pharynx, larynx, palate, parasympathetic innervations of thoracic and abdominal organs sternocleidomastoid and trapezius muscles movement of the tongue

Oh, Oh, Oh, To Take A Family Vacation! Go Vegas After Hours Oh, Oh, Oh, They Traveled And Found Voldemort Guarding Very Secret Horcruxes/Hallows Old Opie Occasionally Tries Trigonometry And Feels Very Gloomy, Vague And Hypoactive Oh, Oh, Oh, To Touch And Feel Vintage Green Velvet, Simply Heaven Once On October Thirteenth, Troublesome Abductors Filched Various Golden Valuables And Heirlooms For sensory, motor or both Some Say Marry Money, But My Brother Says Big Boobs Matter More Some Say Marry Money, But My Brother Says Big Business Makes Money Some Say Mind Matters, But My Brother Says Big Boobs Matters More

Guidelines for Assessing Cranial Nerve Function 1. Health History: pain, seizures, dizziness(lightheadedness vs vertigo), visual disturbances, weakness, abnormal sensations such as numbness 2. Cerebral function: mental status, LOC, thought content, emotional status, motor and language ability 3. Motor system: a. posture and gait b. muscle tone and strength (Ataxia: incoordination of voluntary muscle actions) c. coordination and balance (Romberg test: screen for balance with feet together) 4. Sensory system: tactile sensation, superficial pain, vibration sense, position sense a. Graphestheisa: recognize writing on skin b. Sterognosis: recognize form of an object when placed in the hand c. two point discrimination: ability to dicern two objects that are nearby Examining the Reflexes hyperreflexia: upper motor neuron absent reflex: lower motor neuron 1. biceps reflex: C5, C6 2. triceps reflex: C7, C8 3. Patellar reflex: L4 4. Ankle achillies reflex: S1, S2 (Clonus: prolonged rhythmic contractions) 5. Babinski: if reflex present after age 2: sign of nerve damage CT and MRI, Diagnostic studies Cerebral Angiogram provides visualization of cerebral blood vessels, subtracts bones and tissues so only Purpose vessels are seen Indications Pre-procedure Intraprocedure Postprocedure Complications assessment of blood flow within the brain, ID aneurysms, vascularity of tumors NPO for 4 to 8 hours, asses for iodine allergy, mild sedative usually administered before catheter placed in artery in groin or neck, dye is injected, xrays are taken, additional sedation may be necessary movements are restricted for 8 to 12 hours to prevent rebleeding at catheter site risk for bleeding, check insertion site frequently

Cerebral computed tomography (CT) scan provides cross sectional images of cranial cavity, contrast media may be used Purpose Indications Pre-procedure Intra-procedure Post-procedure Complications used to ID tumors, infarctions, monitor response to treatment, guide needles for biopsies NPO 4 - 8 hours, asses for allergy for iodine, assess BUN (media is excreted through kidneys) CT scanning is painless, sedation only for claustrophobia no follow up care, monitor injection site if media was injected none, other than allergies from media contrast

Electroencephalography (EEG) noninvasive, assesses electrical activity of the brain (EKG but for the brain) Purpose Indications Pre-procedure Intra-procedure Post-procedure Complications use to ID and determine seizure activity, also useful for sleep disorders, behavioral changes if indicated, instruct client to be sleep deprived (increases the likely hood of a seizure event) no risk associated, small electrodes are placed on scalp normal activities may be resumed after none

Glasgow Coma Scale (GCS) assessment of neurological function by assigning a numbered value to functional Purpose levels of cognition Indications Findings: scores are helpful in determining changes in level of consciousness based on: eye opening, verbal response, and motor response, total of three gives score 15: best score Greater than 13: minor head trauma 9 -12: moderate head injury Less than 8: sever head injury

Intracranial pressure (ICP) monitoring device inserted into cranial cavity, records pressure and transmits wave forms on Purpose machine Indications early ID and treatment of increase intracranial pressure, clients who are comatose or have GCS lower than 8 are candidates Normal ICP: 10 to 15 mm Hg head is shaved around insertion location local anesthetic used to numb area, surgical aseptic technique during procedure inspect insertion site every 24 hours, monitor wave forms while monitor is in place infection and bleeding

Pre-procedure Intra-procedure Post-procedure Complications

Lumbar puncture (spinal tap) Small amount of cerebrospinal fluid is withdrawn to be analyzed to determine its Purpose constituents Indications Pre-procedure Intra-procedure Post-procedure Complications used to detect presence of certain disease (multiple sclerosis, syphilis), infection and malignancies risks should be discussed with clients, could result in severe complications position client to stretch spinal canal, cannon ball position monitor puncture site, patient should remain lying for several hours CSF leakage, resulting in headache, increases potential for infection

Magnetic resonance imaging (MRI) scan provides cross sectional images of cranial cavity, contrast may be used to enhance Purpose images, uses magnets so radiation is avoided Indications Pre-procedure Intra-procedure Post-procedure Complications used to detect abnormalities, guide needles for biopsies, able to discriminate soft tissue from tumor or bone cannot have metal, assess for claustrophobia lie in supine position, scan itself is very noisy, usually use headphones if contrast is used, assess puncture/IV site none

Positron emission tomography (PET) and single photon emission computed tomography (SPECT) scans produce three dimensional images of head, glucose based tracer is injected which Purpose initiates metabolic activity that can be imaged Indications Pre-procedure Intra-procedure Post-procedure Complications most useful in determining tumor activity and response to treatment, also presence of dementia cans use radiation, assess for history of DM (due to glucose tracer) lie in supine position no follow up necessary none

Altered level of consciousness 1. considered most important indicator of patients condition 2. LOC is a continuum (full alertness to coma) 3. Coma: unconsciousness, unarousable 4. Akinetic mutism: unresponsiveness, but opens eyes 5. Persistent vegetative state: devoid of cognition but has sleep wake cycles 6. Locked in syndrome: inability to move or respond except eye movement Increased ICP: cerebral edema or accumulation of fluid in brain cause decreased blood flow 1. Monro-Kellie hypothesis: three substances have a homeostasis within the brain (brain tissue, blood, and cerebral spinal fluid). Imbalance in any of these causes increased ICP. 2. Cushings triad: ICP results in hypertension, bradycardia, and bradypnea 3. medical management for ICP: monitoring pressure, oxygenation, osmotic diuretics to dehydrate brain, maintaining cerebral perfusion, reducing CSF volume, controlling fever, reducing metabolic demands Intracranial surgery: 1. craniotomy: opening of skull to remove tumor, relieve ICP, evacuate clots, control hemorrhage 2. Burr holes: making holes in skull, determine cerebral swelling and injury, evacuating hematoma, 3. Medical management: anti-seizures post op, corticosteriods and fluid restriction to reduce fluid restriction, prophylactic antibiotics, anti-anxiety meds Seizure Disorders Seizure: abrupt, abnormal, excessive and uncontrolled electrical discharge of neurons within brain that may cause alteration of consciousness and/or changes in motor and sensory ability

Epilepsy: term used to define medical disorder characterized by chronic recurring abnormal brain electrical activity risk factors: 1. predisposition 2. acute febrile state 3. head trauma 4. cerebral edema 5. abrupt cessation of antiepileptic drugs 6. infection 7. metabolic disorder 8. exposure to toxins 9. brain tumor 10. hypoxia Generalized seizure: (tonic-clonic seizure or grand mal seizure): begins with alteration of vision, then 15 20 seconds of tonic episode, then 1 - 2 minutes of clonic episode 1. tonic seizure: stiffening of muscles 2. clonic seizure: rhythmic jerking of extremities 3. absence seizure, loss of consciousness lasting a few seconds 4. myoclonic seizure, brief jerking or stiffening 5. atonnic or akinetic seizure: few seconds where muscle tone is lost, frequently results in falling Partial or focal/local seizure: 1. complex partial: behaviors such as lip smacking or picking at clothes 2. simple partial: consciousness is maintained throughout, may consist of unusual sensations, autonomic abnormalities, pain or offensive smell. Unclassified or idiopathic seizures: do not fit into other categories, these types account for half of all seizure activities Lab tests: screen for alcohol, illicit drug levels, HIV testing, and excessive toxins Diagnostic procedures: EEG (may identify origin of seizure), MRI, CT, CAT scans, PET, CSF analysis, skull xray are all possibilities to diagnose cause of seizure Nursing care: During a seizure: 1. protect patient from injury 2. position patient to provide patent airway 3. be prepared to suction oral secretions 4. turn patient to side to decrease risk of aspiration 5. loosen restrictive clothing 6. do not attempt to open jaw or insert airway during seizure Post seizure: 1. maintain client in side lying position 2. check vital signs 3. assess for injuries 4. perform neurological checks 5. try to determine possible trigger Medications: phenytoin (Dilantin), should be taken at same time every day Headache Primary: not associated with other diseases (migraine, tension-type, cluster) 1. tension type: 30 min to 7 days (pressing, nonpulsating, mild to moderate, bilateral, nausea, photophobia or phonophobia, higher rate in females) 2. Migraine: a. without aura: 4 to 72 hours (unilateral, pulsating, aggravation by normal activity, nausea, photophobia, phonophobia, more females than males) b. with aura (precedes migraine): symptoms include feeling of dreed and anxiety, unusual fatigue, nervousness or excitement, GI upset, visual of olfactory alterations c. treatment: triptans, SSRIs, Ergotomine, betablockers, CCB, tricyclic antidepressents,

anticonvulscents 3. Cluster: multiple headaches occur daily, last several weeks to months, located behind one eye, severe, more males than females a. opiods, antiemetics, short course of corticosteriods for rescue therapy Secondary: associated with disease states such as tumors, intracranial bleeding, increased ICP, meds such as nitrates