Introduction to the Neurologic System

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Questions and Answers

What is the average annual percentage of brain weight and neuron loss after age 50?

0.5%

1% (correct)

Which of the following changes is NOT associated with normal aging of the nervous system?

Increased brain metabolism (correct)

Loss of interconnections of dendrites

Reduction in cerebral blood flow

Altered sleep-to-wakefulness ratio

What happens to short-term memory in older adults compared to long-term memory?

Short-term memory is more affected. (correct)

Short-term memory is less affected.

Long-term memory declines faster.

Both are equally affected.

Which statements about neurologic disorders in older adults is false?

Dementia is a normal consequence of aging. Signup and view all the answers

Which condition can potentially lead to chronic pain or weakness in older adults?

Nerve irritation from arthritis Signup and view all the answers

What is a common physiological change in the nervous system for older adults?

Decrease in the ability to regulate body temperature Signup and view all the answers

Which factor is NOT considered a risk factor associated with neurovascular diseases in older adults?

Increased physical activity Signup and view all the answers

How does the velocity of nerve impulses typically change with aging?

It decreases. Signup and view all the answers

What are the four categories assessed in the FOUR score coma scale?

Eye response, motor response, brainstem reflexes, respiration pattern Signup and view all the answers

Which type of aphasia is characterized by the inability to comprehend the spoken or written word?

Sensory aphasia Signup and view all the answers

What is the primary function of Broca’s area in the frontal lobe?

Motor speech control Signup and view all the answers

Which type of dysfunction is associated with upper motoneuron lesions?

Spasticity and hyperreflexia Signup and view all the answers

How is sensory aphasia most commonly diagnosed?

With language comprehension evaluations Signup and view all the answers

What does the term 'dysarthria' refer to?

Difficulty in controlling speech muscles Signup and view all the answers

Which cranial nerve is tested by checking visual acuity and visual fields?

II (optic) Signup and view all the answers

What type of tests may be included in the assessment of a neurologically impaired patient?

Blood tests and urine tests Signup and view all the answers

Which condition is indicated by an inability to name objects?

Anomic aphasia Signup and view all the answers

How do the scores from the FOUR score coma scale differ from the Glasgow Coma Scale?

Scores are not summed; each component is considered separately Signup and view all the answers

What is the main condition that a myelogram is primarily used to diagnose?

Herniated or protruding intervertebral disk Signup and view all the answers

What is a common side effect reported by patients during an angiogram procedure?

Feeling extremely hot and flushed Signup and view all the answers

Which step is necessary before performing a myelogram?

Document patient’s allergies, especially to dyes Signup and view all the answers

How long is the expected duration of an electromyogram (EMG) procedure for one muscle study?

45 minutes Signup and view all the answers

What is an important nursing intervention after an angiogram procedure?

Monitor the puncture site for hematoma and check vital signs frequently Signup and view all the answers

What might an increase in the number of lymphocytes in cerebrospinal fluid (CSF) indicate?

Bacterial, fungal, or viral infection Signup and view all the answers

Which situation is most likely to result in low levels of CSF glucose?

Bacterial infection like meningitis Signup and view all the answers

What is the primary purpose of performing a lumbar puncture?

To relieve cerebrospinal fluid pressure Signup and view all the answers

After a lumbar puncture, how long should the patient lie flat in bed?

Several hours Signup and view all the answers

What is a potential discomfort the patient may experience during a CT scan?

Claustrophobia from the scanning process Signup and view all the answers

Why has the use of brain scans decreased compared to CT scans?

CT and MRI provide better diagnostic capabilities Signup and view all the answers

What is the significance of revealing blood in the first specimen of spinal fluid collected?

Results from a puncture complication Signup and view all the answers

Which test is primarily used to assess electrical brain activity?

Electroencephalogram (EEG) Signup and view all the answers

Magnetic Resonance Imaging (MRI) is preferred over CT scans because it yields greater contrast in imaging which type of tissues?

Soft tissue structures Signup and view all the answers

What factor must be assessed before performing an MRI?

Presence of metal in the body Signup and view all the answers

What is one of the most effective measures to increase survival after accidents?

Using seatbelts in cars Signup and view all the answers

Which symptom could indicate a significant neurologic condition?

Sudden changes in visual acuity Signup and view all the answers

Which group of behaviors is critical to prevent neurologic injuries during activities?

Wearing protective helmets Signup and view all the answers

What does a Glasgow Coma Scale score of 8 or less commonly indicate?

Definition of coma Signup and view all the answers

Which factor can impact the outcomes of the Glasgow Coma Scale assessment?

Preexisting factors Signup and view all the answers

What should be included in patient teaching to prevent meningitis?

Prompt treatment of ear and sinus infections Signup and view all the answers

What does decreased level of consciousness usually indicate regarding intracranial pressure?

Increased intracranial pressure Signup and view all the answers

Which orientation component is essential for assessing awareness in a neurological exam?

Orientation to person, place, time, and purpose Signup and view all the answers

What should be noted regarding the patient's mental status during assessment?

Recording actual statements made by the patient Signup and view all the answers

Which of the following is NOT a common indicator of neurologic issues?

Frequent sneezing Signup and view all the answers

Study Notes

Physiological Changes in the Nervous System with Aging

Brain weight and neuron loss averages 1% annually after age 50, with the cortex losing cells more rapidly than the brainstem.
Remaining neurons show structural changes, including reduced interconnections of dendrites.
Cerebral blood flow decreases alongside brain metabolism and oxygen use, contributing to cognitive decline.
Presence of senile plaques, neurofibrillary tangles, and lipofuscin pigments may be observed in aged neurons.
Altered sleep-to-wakefulness ratio and decreased temperature regulation in older adults affect daily function.
Slower reflexes result from reduced blood supply to the spinal cord, impacting reaction times.
Normal aging changes differ from conditions like Alzheimer’s disease, with many older individuals maintaining functional integrity.

Lifespan Considerations and Neurologic Disorders

Neurologic function declines due to neuron loss, leading to slowed reflexes and tremors.
Touch sensitivity and fine motor skills diminish, but most older adults can still learn, though more slowly.
Short-term memory declines more than long-term memory with aging.
Increased incidence of neurological disorders, including Alzheimer’s disease and strokes, occurs with age.
Chronic pain or weakness may arise from arthritis, joint injuries, or spinal cord compression but does not equate to dementia, which may have reversible causes.

Prevention of Neurologic Problems

Many neurological conditions lack a known cause, but lifestyle modifications can prevent or mitigate some issues.
Key risk factors for neurovascular diseases mirror those for cardiac disease: high blood pressure, cholesterol, smoking, obesity, lack of exercise, and stress.
Preventing neurological trauma, particularly through education on safe practices and injury avoidance, is critical.
Immunizations and prompt treatment of infections can prevent complications such as meningitis.

Assessment of Neurologic Function

Comprehensive nursing assessments are crucial for diagnosing neurological diseases.
Essential symptoms include headaches, clumsiness, visual changes, seizures, and personality shifts.
Level of consciousness (LOC) assessment is vital; a decreasing LOC indicates impaired cerebral blood flow and may signal increased intracranial pressure.
The Glasgow Coma Scale (GCS) offers a standardized method for evaluating consciousness impairment and predicts coma outcomes.

Neurological Evaluation Techniques

FOUR Score Coma Scale offers a user-friendly alternative to GCS, especially for intubated patients.
Language and speech assessments are key; aphasia may present in several forms, impacting comprehension and expression.
Cranial nerve function is critically assessed via specific tests for each nerve pair.
Motor and sensory function evaluations help identify abnormal neurological function, with attention to reflexes and muscle tone.

Diagnostic Testing for Neurological Conditions

Blood and urine tests aid in ruling out infections and metabolic disorders contributing to neurological symptoms.
Cerebrospinal fluid (CSF) examination can reveal infections or degenerative diseases; procedures like lumbar punctures are necessary for collecting CSF.
Imaging studies such as CT and MRI scans detect pathologies of the brain and spinal cord, with MRI preferred for its superior soft tissue contrast.
Electrode-based assessments, like EEG, measure brain electrical activity, aiding in diagnosing conditions such as epilepsy and traumatic brain injuries.### EEG (Electroencephalogram)
No special preparation is required; patient should rest quietly before the procedure.
Takes approximately 1 hour; patient's hair and scalp must be clean.
Various patterns are compared from recordings; allow rest after the test.
Assist in washing hair and removing collodion after the procedure.

Myelogram

Myelograms identify lesions in spinal canal compartments using radiopaque dye.
Commonly used for diagnosing herniated disks, spinal tumors, adhesions, and arteriovenous malformations.
Baseline assessment of lower extremity strength and sensation is crucial before the procedure.
Procedure lasts about 2 hours; slight discomfort expected when dura is penetrated.
Water-soluble iodine dyes, such as iopamidol, are usually employed, which are absorbed and excreted by kidneys.
Preparation similar to lumbar puncture; check for allergies, particularly to dyes.
Positioning is typically on the side with knees and head flexed to facilitate lumbar puncture.
CSF is drained for pressure measurements and specimen collection; dye is injected and needle removed.
Post-procedure, a CT scan is conducted 4 to 6 hours later; observe puncture site for CSF leakage.
Common post-mylogram symptoms include headache, nausea, and vomiting; patient should lie flat for several hours.

Angiogram (Cerebral Arteriography)

Visualizes cerebral arterial system using injected radiopaque material.
Detects arterial aneurysms, vessel anomalies, and tumors displacing vessels.
Clear liquids are generally allowed before the procedure; some institutions may restrict all intake.
Assess for iodine allergies, as the dye contains iodine.
Mark pedal pulse locations if using the femoral approach; measure neck circumference for carotid approach.
Baseline vital signs and neurologic checks are critical immediately before the procedure.
Test duration is about 2 to 3 hours, requiring patient to remain still.
Patients often experience warmth, flushing, and metallic taste during dye injection.
Local anesthetic is applied at the puncture site; catheter is inserted into relevant vessels.
After dye injections, pressure is applied to the puncture site for at least 15 minutes.
Bed rest is mandatory for 4 to 6 hours post-procedure, with frequent vital sign and neurologic checks.
Monitor puncture site for hematoma; assess for distant pulses and breathing/swallowing difficulty after carotid stick.
Risks include cerebrovascular accidents and increased intracranial pressure; changes in LOC should be reported immediately.
MRA is increasingly replacing traditional cerebral arteriography.

Carotid Duplex

Combines ultrasound and pulsed Doppler technology to examine the carotid artery.
Probe is placed over carotid artery to assess blood flow to bifurcation of internal and external carotid arteries.
Ultrasound signals reflect off moving blood cells, registering blood velocity.
Increased flow velocity may indicate stenosis; often ordered after transient ischemic attacks (TIA).

Electromyogram (EMG)

Measures muscle contraction response to electrical stimulation, assessing lower motor neuron diseases and neuromuscular junction defects.
One muscle study takes about 45 minutes; electrode insertion may cause discomfort.
Monitor for bleeding at electrode insertion site post-procedure; analgesics may be needed for relief.

Echoencephalogram

Uses ultrasound to visualize and depict intracranial brain structures.

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Description

Explore the physiological changes that occur in the nervous system with aging, including loss of brain weight, neuron decline, and the structural changes that impact cognitive function. Understand how these changes affect cerebral blood flow and overall brain metabolism in older adults.