Neurological Unit 11

A nurse is preparing a client for a CT scan that requires an infusion of radiopaque dye. Which question is the most important for the nurse to ask?

"Are you allergic to seafood or iodine?"

A score of this on the GCS is a cause of concern on a client?

3

A break/fracture in which spinal nerves would result in the worst prognosis?

Cervical Nerves

This lobe is located behind the forehead and serves tor emulate and mediate the higher intellectual functions

Frontal lobe

Parietal lobe

Interprets sensations and determines right from left and where the body is in relation to the environment

Cerebellum

Located behind and below the cerebrum Responsible for muscle movement

What is the basic cell of the nervous system responsible for transmission?

Neuron

This lobe is located at the upper back portion of the brain. Function is processing sensory information regarding parts of the body. Interprets visual information, processing language and math.

Parietal lobe

A nurse conducts the Romberg test on a client by asking the client to stand with the feet close together and the eyes closed. As a result of this posture, the client suddenly sways to one side and is about to fall when the nurse intervenes and saves the client from being injured. How should the nurse interpret the client's results?

Positive Romberg test, indicating a problem with equilibrium

Temporal lobe

Processes taste, smell and hearing stimuli Also important in long term memory

Occipital lobe

Processes visual stimuli

A client scheduled for magnetic resonance imaging (MRI) has arrived at the radiology department. The nurse who prepares the client for the MRI should prioritize what action?

Removing all metal-containing objects

Where does the spinal cord end?

The spinal cord begins at the bottom of the brain stem, the medulla oblongata, and ends in the lower back where it tapers to form a cone called the conus medullaris

Frontal lobe

Voluntary motor control on the opposite side of the body and determines emotions, motivation, complex thinking, judgement, personality

Discuss the lumbar puncture

"Spinal tap" is performed to obtain samples of CSF form the subarachnoid space for lab exams and to measure CSF pressure. Strict aseptic technique is required during the procedure, used for injecting a drug into subarachnoid space, to administer a spinal anesthetic, to withdraw CSF for relief of ICP, or to infect air, gas or dye for a neurological diagnostic procedure. The design of the needle has been improved to decrease the occurrence of spinal headaches following a spinal tap. If the dura mater is accidentally punctured during the procedure, the changes of headache are higher

The nurse is assisting with a lumbar puncture and observes that when the physician obtains a CSF, its clear and colorless. What does this finding indicate?

A normal finding, the fluid will be sent for testing to determine other factors

If the patient has problems with balance and posture, the nurse should know the patient is having problems with which side of the brain?

Cerebellum: responsible for muscle movement

Four Major Structures of the Brain

Cerebrum - consists of 2 hemispheres connected by the corpus callosum (band of white fibers that act as a bridge for transmission of impulses between the left and right hemispheres) Each hemispheres has 4 lobes: 1. Frontal 2. Parietal 3. Temporal 4. Occipital Cerebral cortex is the surface of the cerebrum and contains motor and sensory neurons

right brain hemisphere

Controls sensation and movement on the LEFT side of the body. Damage to the right hemisphere will result in: Visual changes Loss of spatial awareness Loss of depth perception Short attention span Poor impulse control Impaired judgement One sided neglect syndrome, patient cannot see, move or feel left side

left cerebral hemisphere

Controls sensation and movement on the RIGHT side of the body Damage to the left hemisphere will result in: Inability to speak and understand Difficulty problem solving, reasoning, and calculations Visual changes One sided negate syndrome on right side

Trigeminal - chewing face & mouth touch & pain

Cranial Nerve V(5)

Vagus

Cranial Nerve X

What does GCS stand for?

Glasgow Coma Scale- Level of consciousness

CSF(Cerebral Spinal Fluid)

Helps further protect your brain and spinal cord from injury and infectious organisms Helps maintain a constant ICP barrier to toxic metabolites, drugs and floats the brain

Diencephalon

Located at the base of the brain just above the brainstem under the cerebrum 4 main structures: Thalamus: regulates alertness and consciousness Hypothalamus: Most important structure in the brain, connects to the pituitary gland and maintains homeostasis

Purpose of Meninges and CSF

Meninges: 3 membranes that cover the brain. Protects the CNS from injury, essentially holds your brain in place

It is located at the back of the brain, near the medulla, and functions as the visual processing center

Occipital lobe

The left hemisphere of the brain controls which side motor coordination?

RIGHT

What is an appropriate intervention for a dementia patient?

Reorient

A patient is upset that they do not have full strength of one side of their body following a stroke. They suffer from poor impulse control, loss of depth perception and cannot see out of their left side. Which hemisphere did the patient experience a stroke?

Right sided

A nurse is performing a neurologic assessment on a client with a stroke and cannot elicit a gag reflex. This deficit is related to cranial nerve (CN) X, the vagus nerve. What will the nurse consider a priority nursing diagnosis?

Risk for aspiration

What is the difference between sensory and motor neurons?

Sensory neurons carry impulses from the skin/muscles to the central nervous system. Motor neurons carry impulses from the central nervous system to the muscles for contraction and to glands to release secretions.

I tasted this food and it was very salty. I am able to taste and smell from which lobe? It is located behind the ears.

Temporal lobe

What are you assessing when checking for PERRLA?

The Eyes PERRLA Pupils Eyes Round Reactive to Light Accommodation

Where does the lumbar puncture go?

The lumbar puncture occurs between the 3rd and 4th lumbar vertebrae in the subarachnoid space

The Spine

There are 31 spinal nerves: 8 cervical C1-C8 12 thoracic T1-T12 5 lumbar L1-L5 5 sacral S1-S5 1 coccygeal C0

What is the PNS? Regarding the Autonomic Nervous System

This is the Peripheral Nervous System, which consists of the cranial nerves, spinal nerves and autonomic nervous system. The autonomic nervous system regulates respiration, heart rate, digestion and urinary function.

What is the CNS?

This is the central nervous system, which consists of the brain and spinal cord

Patient is having problems with anger and quickly becomes frustrated because he cannot speak and understand what the nurse is saying. The nurse should know this is normal for a patient with LEFT cerebral hemisphere trauma. TRUE or FALSE

True, the nurse should recognize this is referred to as ataxia, this is common result of someone who suffered a stroke on the left side

When assessing gait on a client, how would you document the client is wobbly?

Unsteady gait

Brain stem

midbrain, pons, medulla oblongata Midbrain: connects the pons and cerebellum with two cerebral hemispheres Pons: located between midbrain and the medulla. Connects the two hemispheres of the cerebellum with the brainstem, spinal cord, and cerebrum Medulla Oblongata: lies between the pons and transmits motor impulses from the brain to the spinal cord and sensory impulses from the peripheral sensory neurons to the brain