1. 10 main functions of the frontal lobe
    • primary motor area
    • broca's speech center on the dominant side
    • voluntary eye movement
    • access to current sensory data
    • access to past info or experience
    • affective response to a situation
    • regulates behavior based on judgement and foresight
    • judgement
    • ability to develop long-term goals
    • reasoning, concentration, abstraction
  2. 5 main function of parietal lobe
    • understand sensation, texture, size, shape, and spatial relationship
    • three-dimensional (spatial) perception
    • important for singing, playing musical instruments, and processing nonverbal visual experiences
    • perception of body parts and body position awareness
    • taste impulses for interpretation
  3. 3 main function of the temporal lobe
    • auditory center for sound interpretation
    • complicated memory patterns
    • wernicke's area for speech (process language)
  4. function for occipital lobe
    primary visual center
  5. 2 function for limbic lobe
    • emotional and visceral patterns connected with survival
    • learning and memory
  6. brainstem function --medulla--3
    • cardiac-slowing center
    • respiratory center
    • cranial nerves IX (glossopharyngeal), X (accessory), and XII (hypoglossal) emerge from the medulla, as do portions of cranial nerves VII (facial) and VIII (acoustic)
  7. brainstem function--pons--3
    • cardiac acceleration and vasoconstriction centers
    • four cranial nerves orginate from the pons- V (trigeminal), VI (abducens), VII (facial), VIII (acoustic)
    • pheumotaxic center helps control respiratory pattern and rate
  8. brainstem functions-- midbrain
    • contains the cerebral aqueduct or aqueduct of Sylvius
    • location of periaqueductal gray, which may abolish pain when stimulated
    • cranial nerve nuclei III (trochlear) located here
  9. what are the two types of neurologic assessments may be performed
    a complete assessment and a rapid assessment
  10. what is the first indication that central neurologic function has declined
    a change in loc (level of consciousness)
  11. describe pt who is lethargic
    drowsy, or sleepy but easily awakened
  12. describe pt who is stuporous
    one who is arousable only with vigorous or painful stimulation
  13. describe pt who is comatose
    pt is unconscious and cannot be aroused
  14. what are the three types of loss of memory
    long-term (remote), recall (recent), and immediate memory
  15. what is remote (longterm) memory
    memory can be tested by asking pts about their birth date, schools attended, city of birth, or anything from the past that can be verified
  16. what is recall (recent) memory
    • can be tested during the hx and checked on medical record
    • -the accuracy of the medical hx
    • -dates of clinics or md appt
    • -the time of admission
    • -health care providers seen with the past few days
    • -mode of transportation to the hospital or clinic
  17. what is immediate (new) memory
    is tested by giving the pt two or three unrelated words and asking them to repeat the word to make sure they heard. then ask them to state the words five min later
  18. proprioception
    involvement of only posterior column leads to lost --position sense--below the level of the damage on the same side or on both sides
  19. lesion on right spinothalamic tract
    results in a loss of pain and temp sensation below the lesion on the left side
  20. problems in the brainstem, thalamus, and cortex/ assess brainstem integrity
    • result in loss of sensation on the contralateral (opposite) side of the body//
    • -close eyes and hold arms perpendicular to the body with the palms up for 15 to 20 seconds.. if brainstem reason for muscle weakness, the arm on the weak side will start to fall or drift with the palm pronating
  21. cerebellar lesions affect/assessment of cerebellar function
    • sensations on the same side of the body
    • -fine coordination of muscle activity is tested
    • -gait and equilibrium
  22. GCS establishes data baseline for
    eye opening, motor response, verbal response
  23. decorticate
    abnormal posturing seen in pts with lesions that interrupt the corticospinal pathways. the pts arm, wrists, and fingers flexed w/internal rotation and plantar flexion of the legs
  24. decerebration
    • abnormal posturing and rigidity characterized by extension of the arms, legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which body is bowed forward)
    • -usually associated with dysfunction in the brainstem area
  25. head trauma and multiple injuries
    one of the first priorities is to rule out cervical spine fracture
  26. x rays skull and spine
    • radiation is minimal
    • follow up care not required
    • determine
    • -bony fractures
    • -curvatures
    • -bone erosion
    • -bone dislocation
    • -calcification of soft tissue which can damage the nervous system
  27. cerebral angiography
    • done to visualize the cerebral circulation to detect blockages in the arteries or veins in the brain, head or neck
    • contrast injection in artery
    • to identify
    • -aneurysms
    • -traumatic injuries
    • -strictures/occlusions
    • -tumors
    • -blood vessels displacement from edema
    • arteriovenous malformations
    • dentures and hearing aides must be removed
    • ekg
    • sedation usually not used/med to relax
    • risk--hives from contrast, thrombosis, bleeding from site
    • pts with known contrast sensitivity are pretreated with steroids
  28. ct computed tomography
    scanning is an accurate, quick, easy, noninvasive, painless, and least expensive method of diagnosing neurologic problems
  29. mri
    • produces images better than ct scan
    • does not use ionizing radiation instead magnetic field
  30. pet scan
    • it provides info about the function of the brain, specifically glucose and oxygen metabolism and cerebral blood flow
    • npo the night before for am testing
    • npo four hours before afternoon testing
    • perform mental functions to see certain parts of the brain
  31. electromyograpgy emg
    identify nerve and muscle disorders as well as spinal cord disease
  32. electroencephalography eeg
    • records the electrical activity of the cerebral hemispheres
    • represents the voltage changes in various areas of the brain
    • determine the origin on seizure activity
    • determine cerebral function in
    • pathologic conditions other than epilepsy, such as tumors, abscesses, cerebrovascular disease, hematomas, injury, metabolic disease, drug intoxication
    • diff between organic and hysterical blindness and deafness
    • monitor cerebral activity during surgical anesthesia
    • dx sleep disorders
    • determine brain death
  33. lumbar puncture spinal tap
    • obtain csf pressure readings with manometer
    • obtain csf for analysis
    • check spinal blockage caused by spinal cord lesion
    • inject contrast medium /air for diagnostic study
    • inject spinal anesthetics
    • inject certain drugs
    • reduce mild to moderate increased icp in certain conditions
    • clear/colorless--normal
  34. normal csf findings
    • pressure- less than 20cm h2O
    • clear, colorless
    • cells- 0-5 small lymphocytes
    • proteins- 15-45
    • --50-200 viral infection
    • -->500 bacterial infection gbs
    • glucose- 50-70
  35. instructions for eeg
    • sleep deprived-- remind the pt to wake up about 2-3am and stay awake for the rest of the night
    • avoid cns depressants/stimulants
    • dont drink caffeine fluids day of exam
    • test not dangerous
    • wash hair morning of hairpins or accessories
    • will need to rewash hair after exam bcse of glue
  36. postprocedural instrctns after cerebral angiography
    • keep leg straight and immobilized x2hr
    • maintain ice pack and pressure dressing to insertion site x2hr
    • neurocirculation checks every 15 min x2hrs then every hr x4 hrs
  37. rombergs sign
    pt sways with the eyes closed but not when the eyes are open--proprioceptive (awareness of body position)
  38. touch discrimination
    close eyes and point to where provider has just touched you--random positioning
  39. Gordons assessment scale
    • level 0= full self-care
    • level I= requires use of equipment or device
    • level II= requires assistance or supervision of another person or equipment or device
    • level IV= is dependent and does not participate
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