| A | B |
|---|
| Acute Pain | (1) medically significant pain, usually of recent origin, that draws attention to the experience and lasts from seconds to six months |
| Affected Reflexes | (1) occur w/upper motor lesions (2) incl deep tendon reflexes & diminished or absent superficial reflexes & pathological reflexes like the Babinski response occur (3) there is little or no muscle atrophy & the muscles remain permanently tense, exhibiting spastic paralysis or paresis |
| Afferent Pathways | (1) convey sensory information to the cerebral cortex, or they may cross at the level of the spinal cord or in the medulla |
| Afferent Pathways | (1) convey sensory information to the cerebral cortex, or they may cross at the level of the spinal cord or in the medulla |
| Assessment of Flat Affect Questions | (1) Does the patient’s mood fluctuate normally, unpredictably, or not at all? (2) Are the patient’s words & thought content appropriate? (3) Is the patient’s verbal communication consistent with nonverbal cues? |
| Athetosis | (1) slow, squirming, writhing movement |
| Autoregulation | (1) ability of the brain to automatically change the diameter of its blood vessels to maintain constant cerebral perfusion pressure (CPP) (2) when systolic blood pressure is between 60 & 160 mmHg & ICP is <40 mmHg, autoregulation is effective (3) when autoregulation fails, cerebral blood flow diminishes & ischemia leading to infarction follows (4) w/drop in blood flow comes a drop in CPP (determined by subtracting ICP from the mean arterial blood pressure) |
| Axons | (1) the axon of a nerve in where sensory information originates & enters the sc by the posterior root (2) conveying heat, cold & pain immediately enter the posterior gray column of the sc, where they make connections w/cells of secondary neurons (3) these pain & temperature fibers then cross immediately to the opposite side of the cord and course upward to the thalamus |
| Axons Crossing | (1) position & vibratory sensation are produced by stimuli arising from muscles, joints & bones & are uncrossed until the medulla, where the axons of secondary neurons cross to the opposite side & then proceed to the thalamus (2) destruction of a sensory nerve thus results in total loss of sensation in an area of distribution & complete transection of the sc produces complete anesthesia below the level of injury (3) otherwise, depending on the extent of injury to the sc (because of the tracts’ positions & where they cross), some sensation may be preserved & others lost |
| Basal Ganglia Damage Symptoms | (1) incl muscle rigidity, problems of posture & abnormal movement (athetosis: slow, squirming, writhing movements) or chorea |
| Bradypnea | (1) abnormally slow breathing |
| Brain Dead | (1) may be considered after SCI has been ruled out (2) any sedating med have worn off & other neurological problems have been discounted |
| Cerebral Perfusion Pressure (CPP) | (1) determined by subtracting ICP from the mean arterial blood pressure |
| Cerebellar Dysfunction Symptoms | (1) incl ataxia, lack of coordination, seizures, CSF obstruction, brain stem compression |
| Chronic Pain | (1) persists for longer than six months (2) suppresses immune function, may result in depression & disability & needs to be treated w/pain control strategies |
| Coma | (1) a clinical state of unconsciousness in which the pt is unaware of self or the environment for prolonged periods of time (days, months, or years) (2) similar to a persistent vegetative state, in which there is wakefulness but devoid of consciousness content & w/o cognitive or affective mental function |
| Comatose | (1) pt is subject to respiratory failure & all problems assoc w/immobility (pressure ulcers, venous stasis, musculoskeletal deterioration, contractures, disturbed gastrointestinal functioning, pneumonia & aspiration) (2) medical management incl treating the cause of coma & maintaining an airway (intubation & a ventilator may be necessary), maintaining fluid balance through IV therapy, maintaining nutritional support through feeding tubes & monitoring circulatory status (VS & BP) |
| Complete Ischemia | (1) more than three to five minutes results in irreversible brain damage |
| Cushing’s Reflex | (1) in the event of autoregulation failure, the brain’s attempt to restore blood flow by increasing arterial blood pressure to overcome rising intracranial pressure |
| Cushing’s Triad | (1) occurs when Cushing’s reflex is no longer effective (2) the triad consists of bradycardia, hypertension & bradypnea |
| Decerebration (Decerebrate Posturing) | (1) more ominous than decorticate posturing (2) a motor symptom of cerebral trauma resulting from lesions at the midbrain (3) pt has extension & external rotation of the arms, wrists, extension, plantar flexion & internal rotation of the feet |
| Decortication ( Decorticate Posturing) | (1) a motor symptom of cerebral trauma resulting from lesions of the internal capsule or cerebral hemispheres in which the pt has flexion & internal rotation of the arms, wrists, extension, internal rotation & plantar flexion of the feet |
| Diabetes Insipidus (DI) | (1) result of decreased secretion of antidiuretic hormone (2) pts will exhibit excessive urine output with low specific gravity or osmolality |
| Emotional Lability | (1) behavioral alteration that may be seen w/corticosteroid therapy or conditions that affect cerebral function (2)marked by emotions that frequently and widely fluctuate |
| Flaccid Posturing | (1) motor symptom of cerebral trauma resulting from lower brain stem dysfunction (2) there is no motor function (3) muscles are limp & lack tone |
| Flaccidity Preceded by Decerebration | (1) following cerebral injury indicates serious neurological impairment |
| Flat Affect | (1) behavioral alteration in which a patient exhibits little or no emotional reaction & any mood fluctuations need to be observed (2) seen in conditions that affect cerebral function |
| Glasgow Coma Scale | (1) used to assess (LOC) (2) based on 3 criteria of eye opening response, verbal response & motor response to verbal commands (3) best response to predetermined stimuli is recorded (unconsciousness is a condition of unresponsiveness to & unawareness of environmental stimuli (4) this state of consciousness does not endure for long (minutes to hours) (5) score of 10 or < on the GCS requires emergency attention & a score is 7 or <is probably in a coma |
| Herniation | (1) neurological complication that occurs when a portion of brain tissue shifts from an area of high pressure to an area of lower pressure |
| Impaired Neurological Status Manifestation | (1) exhibited as problems of the brain, nerves, or spinal cord may also exhibit |
| Increased Intracranial Pressure | (1) pathological condition affecting cerebral perfusion & producing distortion & shifts in brain tissue (2) may reduce cerebral blood flow, leading to ischemia or cell death |
| Increased Intracranial Pressure (Immediate Tx) | (1) aimed at (a) decreasing cerebral edema (b) lowering the volume of CSF (c) decreasing blood volume while maintaining cerebral perfusion (2) involves administering osmotic diuretics (sometimes corticosteroids), restricting fluids, draining CSF, hyperventilating (w/caution), controlling fever &/or reducing cellular metabolic demands |
| Increased Intracranial Pressure Hallmarks | (1) vasomotor center activates & (a) systemic BP rises to maintain cerebral blood perfusion pressure (b) PR slows & is bounding (c) R are irregular (d) unequal pupils (results when one hemisphere of the brain is pressing on the oculomotor nerve) |
| Increased Intracranial Pressure (High Signs) | (1) pupils that react sluggishly, remain pinpoint, or do not react at all (2) other visual disturbances may incl diplopia, blurred vision, loss of extraocular movement (EOM) of the eye, or blindness in any field of the eye (3) in an unconscious pt, EOMs are evaluated by the doll’s eye maneuver (the oculocephalic reflex) |
| Ischemia (Early Stages) | (1) vasomotor center activates & (a) systemic BP rises to maintain cerebral blood perfusion pressure (b) PR slows & is bounding (c) R are irregular (2) these changes in VS are hallmarks of increased ICP |
| Increased Intracranial Pressure & Respiratory Complications | (1) may show periods of apnea or central hyperventilation patterns (2) changes in respiratory patterns indicate pressure on the medullary respiratory center |
| Lower Motor Lesions | (1) occur when a motor nerve is severed between the muscle & spinal cord resulting in flaccid paralysis, absent reflexes & atrophied muscles (from disuse) (2) some causes of lower motor neuron disease incl trauma, infection, poliomyelitis, toxins, vascular disorders, congenital malformations, degenerative processes & neoplasms (3) compression of nerve roots by herniated intervertebral discs is a common cause of such problems |
| Masked Face | (1) immobilization of the facial muscles that presents as a masklike appearance (2) assoc w/Parkinson’s disease & pathology of the basal ganglia |
| Monro-Kellie Hypothesis | (1) relationship illustrating that if there is a change in one cranial compartment, there must be reciprocal changes in the other compartments to maintain equilibrium by displacing or shifting the contents (2) if a compensatory change does not occur, intracranial pressure will rise, thus precipitating a number of changes |
| Motor Cortex | (1) vertical band of cells w/in each cerebral hemisphere governing voluntary movements of the body (2) injury to specific cells in the motor cortex produces paralysis (loss of function) or paresis (weakness or slight or partial loss of function) in the part of the body controlled by those cells. Lesions of the upper motor neurons or pathways (injuries from stroke, head injury, or spinal cord injury) may produce paralysis |
| Neurological Assessment Status | (1) begins w/observation of pt’s (a) appearance & behavior (b) level of verbal response & LOC thru speech & noting whether pt is alert, responsive, drowsy or stuporous (3) changes in LOC precede all other changes in VS & neurological signs |
| Neurological Dysfunction Manifestion | (1) appears as impaired sensory function (2) the thalamus, a major receiving & transmitting center for afferent sensory nerves, is (a) connected to the midbrain & serves to integrate sensory impulses (except olfaction) (b) makes possible conscious awareness of pain, recognition of variations in temperature and touch, sensation of movement, sensation of position & recognition of the size, shape & quality of objects |
| Normal Cerebral Perfusion Pressure CPP | (1) 70 to 100 mmHg (2) CPP <50 mmHg may experience irreversible neurological dysfunction |
| Paralysis | (1) loss of function of a body part |
| Paresis | (1) weakness or slight or partial loss of function |
| Persistent Vegetative State | (1) condition in which the patient is described as wakeful, but is devoid of conscious content and without cognitive or affective mental function |
| Physical Examination W/suspected Neurological Dysfunction | (1) an assessment of behavior incl observations about dress, grooming & personal hygiene (2) posture, gestures, movements, facial expressions & motor activity |
| Physical Examination W/suspected Neurological Dysfunction Flat Affect | (1) seen in conditions that affect cerebral function (2) exhibition of little or no emotional reaction & any mood fluctuations need to be observed |
| Scanning Speech | (1) form of speech in which the patient speaks in a breathy, hesitant manner (2) commonly associated w/multiple sclerosis, it occurs because of patchy demyelination of the speech-related tracts of the CNS |
| State of Unconsciousness or Unconsciousness | (1) for any of these states to occur, both hemispheres of the brain, the brain stem, or the reticular activating system must be involved (2) causes of unconsciousness (which impact the brain) incl head injury, massive stroke, drug or alcohol abuse & hepatic, metabolic & renal failure |
| Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) | (1) result of increased production of antidiuretic hormone (2) pt retains too much fluid & urine has a high specific gravity & osmolality |
| Thalamus | (1) a major receiving & transmitting center for the afferent sensory nerves & serves to integrate sensory impulses (except olfaction) (2) plays a prominent role in (a) conscious awareness of pain (b) recognition of variations in temperature & touch (c) sensation of movement & position (d) recognition of the size, shape & quality of objects |
| Unconsciousness | (1) condition in which the patient is unresponsive to & unaware of environmental stimuli |
| Upper Motor Lesions | (1) in presence of lesions, reflex actions (involuntary movements) become hyperactive (spastic) |
