Introduction to the Neurologic System

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Questions and Answers

What is a physiological change in the nervous system that occurs with aging?

Increase in brain weight

Decrease in interconnections of dendrites (correct)

Increase in cerebral blood flow

Regeneration of neurons

What happens to the neurons of older adults?

They become more interconnected

They regenerate rapidly

Their size increases significantly

They may contain senile plaques (correct)

Which change is NOT associated with normal aging in the nervous system?

Reduced reflexes

Decline in brain metabolism

Increased velocity of nerve impulses (correct)

Altered sleep-to-wakefulness ratio

How does aging affect sleep patterns in older adults?

They often have an altered sleep-to-wakefulness ratio Signup and view all the answers

What might happen to the blood supply to the spinal cord in older adults?

It decreases, leading to slower reflexes Signup and view all the answers

What can hinder care or rehabilitation of older patients despite normal aging changes?

Normal alterations in neurologic function Signup and view all the answers

Which statement accurately reflects changes in neuromuscular function due to aging?

Fine motor coordination diminishes Signup and view all the answers

What is the relationship between aging and short-term memory?

Short-term memory is more affected by aging than long-term memory. Signup and view all the answers

Which of the following is NOT considered a reversible condition that may lead to dementia?

Alzheimer's disease Signup and view all the answers

Which risk factor is associated with both neurologic and cardiac diseases?

High blood pressure Signup and view all the answers

What is a primary method for preventing neurologic injuries from trauma?

Encourage safe driving practices. Signup and view all the answers

When assessing a patient’s level of consciousness, which component is most fundamental?

Wakefulness Signup and view all the answers

Which of the following is a critical indicator of changes in a patient’s neurologic status?

Changes in level of consciousness. Signup and view all the answers

What is a primary reason MRI is preferred over CT scans for neurologic diseases?

MRI provides greater contrast in soft tissue images. Signup and view all the answers

Which procedure utilizes differential radio waves and magnetic field signals to evaluate blood vessels?

Magnetic Resonance Angiography Signup and view all the answers

During a myelogram, what is the primary purpose of observing the flow of radiopaque dye?

To identify lesions in the spinal canal. Signup and view all the answers

What potential side effect should patients expect after undergoing a myelogram?

Headache that may be accompanied by nausea. Signup and view all the answers

What precaution is critical before performing an angiogram regarding the patient's health history?

Check for allergies to iodine. Signup and view all the answers

In the Glasgow Coma Scale, what score indicates a patient is most likely in a coma?

8 Signup and view all the answers

Which area of the brain is most commonly associated with sensory aphasia?

Temporal lobe Signup and view all the answers

How does the FOUR Score Coma Scale improve upon the Glasgow Coma Scale for intubated patients?

It assesses brainstem reflexes. Signup and view all the answers

What type of aphasia is characterized by the inability to speak or write using symbols of speech?

Motor aphasia Signup and view all the answers

Which cranial nerve is responsible for testing visual acuity?

Optic Signup and view all the answers

What is the primary focus of the Glasgow Coma Scale?

Predicting coma duration and outcome Signup and view all the answers

Which type of dysfunction is characterized by muscles being flaccid and weak?

Lower motoneuron dysfunction Signup and view all the answers

What aspect of language assessment may pose challenges due to language and cultural differences?

Speech and language capability Signup and view all the answers

What scoring value represents a neurologically impaired patient on the Glasgow Coma Scale?

3 Signup and view all the answers

Which type of examination can reveal conditions that the patient may be unaware of?

Sensory examination Signup and view all the answers

What is a common finding in cerebrospinal fluid (CSF) during an infection?

Increased lymphocytes Signup and view all the answers

What is the primary purpose of a lumbar puncture?

To relieve pressure and drain excess fluid Signup and view all the answers

During a computed tomography (CT) scan, what is a necessary action if contrast medium is used?

Document allergies to iodine and seafood Signup and view all the answers

What symptom may develop after a lumbar puncture indicating a potential complication?

Persistent headaches Signup and view all the answers

What can be assessed via urine tests in a neurologically impaired patient?

Diabetes insipidus indications Signup and view all the answers

What condition might lead to elevated spinal fluid protein levels?

Degenerative disease or brain tumor Signup and view all the answers

Which of the following cranial nerves control eye movements?

CN III, IV, VI Signup and view all the answers

What physiological change occurs in the nervous system of older adults?

Decline in interconnections of dendrites Signup and view all the answers

How does aging impact reflexes in older adults?

Reflexes slow down due to decreased blood supply to the spinal cord Signup and view all the answers

What is a common neurological change associated with aging?

Loss of brain weight and neurons Signup and view all the answers

What effect does aging have on fine motor skills?

Diminished sense of touch Signup and view all the answers

What is a common misconception about dementia in older adults?

Dementia is always a result of aging. Signup and view all the answers

Which of the following is a risk factor for neurovascular diseases?

High stress Signup and view all the answers

What factor can lead to chronic pain or weakness in older adults?

Nerve irritation due to trauma. Signup and view all the answers

When assessing a patient's level of consciousness, which component is considered higher-level function?

Orientation Signup and view all the answers

Study Notes

Introduction to the Nervous System

Overview includes assessment, labs, and diagnostics related to the nervous system.
Learning objectives emphasize building knowledge on neurologic assessments.

Aging and the Nervous System

Brain weight and neuron loss: 1% annually after age 50, with the cortex losing cells faster than the brainstem.
Structural changes in remaining neurons and decline in dendritic interconnections.
Decreased cerebral blood flow and metabolism, contributing to cognitive decline.
Altered sleep patterns and thermoregulation in older adults.
Symptoms may include tremors and diminished fine motor coordination; however, dementia is not a normal aging consequence.

Prevention of Neurologic Problems

Many conditions are preventable through lifestyle modifications.
Key risk factors: high blood pressure, cholesterol, smoking, obesity, and stress.
Trauma prevention strategies include education on safe driving and substance use.

Nursing Assessment

Essential for diagnosing neurological conditions, focusing on symptom specifics and patient perceptions.
Important symptoms: unusual headaches, loss of extremity function, visual changes, seizures, personality shifts.
Assessing mental status includes evaluating orientation, memory, mood, and behavior.
Level of consciousness is critical; changes indicate potential cerebral impairment.

Levels of Consciousness

Glasgow Coma Scale (GCS) assesses consciousness severity; total score ranges from 3 to 15.
FOUR Score Coma Scale assesses cognitive functions and is particularly useful in intubated patients.

Language and Speech Assessment

Aphasia is a language dysfunction due to cerebral cortex injuries, affecting speech, reading, writing, and understanding.
Types of aphasia include receptive (Wernicke’s area), expressive (Broca’s area), and global aphasia.
Dysarthria refers to poorly articulated speech due to muscle control issues.

Cranial Nerve Function

Twelve cranial nerves tested for various functions: olfactory (smell), optic (vision), oculomotor (eye movement), and others related to facial sensation and movement.
Normal or abnormal responses help identify issues with different cranial nerves.

Motor Function Examination

Evaluates gait, muscle tone, coordination, and reflexes.
Abnormal muscle responses indicate motor neuron dysfunction, distinguishing between upper and lower motoneuron lesions.

Sensory and Perceptual Evaluation

Typically challenging; assesses pain, touch, temperature, and proprioception.
May reveal conditions unknown to the patient.

Diagnostic Examinations

Blood and urine tests assist in ruling out infections or drug impacts.
Cerebrospinal fluid (CSF) analysis helps diagnose meningitis and other conditions.
Lumbar puncture is a vital procedure for CSF collection and requires post-procedure monitoring.

Imaging and Scanning Techniques

CT scans provide detailed images for diagnosing cerebrum and spinal cord conditions.
Contrast medium may be used but requires patient monitoring for allergies and pre-procedure preparation.

Key Considerations

Proper documentation of observations is crucial, avoiding vague descriptions like "disoriented."
Continuous assessment and patient education enhance neurological care.### Imaging Techniques in Neurology
Brain scans like MRI and CT are less frequently used due to advanced accuracy from CT and MRI.
MRI utilizes magnetic forces to create images, helpful for detecting conditions such as stroke, multiple sclerosis, tumors, trauma, herniation, and seizures.
MRI is preferred for diagnosing neurologic diseases due to its superior soft tissue contrast compared to CT scans.
New MRI advancements include diffusion-weighted imaging and magnetic resonance spectroscopy.

MRI Procedure Highlights

Patient eligibility must be assessed for any metal in the body (e.g., orthopedic devices, pacemakers).
Procedure duration: 45 to 60 minutes, performed while the patient lies supine.
Patients may experience discomfort from stillness and claustrophobia during “closed MRI”.

Magnetic Resonance Angiography (MRA)

MRA employs radio waves and magnetic fields to visualize blood flow in cerebral arteries.
It is a noninvasive method for identifying arterial blockages or occlusions.

Electroencephalogram (EEG) Essentials

EEG measures electrical activity to assess brain disorders like epilepsy, tumors, and brain injuries.
Typically, no special preparation is needed; encourage patient rest prior to the test.
The test lasts about 1 hour, requires clean hair and scalp.

Myelogram Details

A myelogram identifies lesions in the spinal canal using radiopaque dye injected into the subarachnoid space.
Most commonly used for detecting herniated disks and spinal tumors.
Prior to the test, evaluate lower extremity strength and sensation baseline.
The procedure lasts about 2 hours and may involve slight discomfort.

Angiogram Overview

Angiogram visualizes cerebral arteries using injected radiopaque materials to detect issues like aneurysms or vessel anomalies.
Baseline assessments include measuring vital signs and checking for iodine allergies.
The procedure can take 2 to 3 hours; discomfort from lying still is common.
Patients often report feeling flushed and experiencing a metallic taste during dye injection.

Carotid Duplex Examination

A combination of ultrasound and pulsed Doppler technology assesses blood flow velocity in the carotid artery.
Increased velocity can indicate stenosis, often evaluated following transient ischemic attacks (TIA).

Electromyogram (EMG) Insights

EMG assesses muscle contraction in response to electrical stimulation, identifying motor neuron disease and neuromuscular junction defects.
Duration for one muscle study is approximately 45 minutes; discomfort may occur during electrode insertion.
Post-procedure monitoring for bleeding or discomfort at the insertion site is essential.

Echoencephalogram Summary

Echoencephalograms utilize ultrasound to visualize intracranial structures of the brain.

Nursing Considerations for MRI

Remove all metallic items including watches and jewelry.
Inquire about the presence of any metal implants or devices in the patient’s body.
Inform the patient about expected machine noise during the MRI procedure.