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Diencephalon= thalamus and hypothalamus
part of the autonomic system which is part of the peripheral nervous system
responsible for regulating the water balance, appetite, vital signs, sleep cycles, pain perception and emotional status
the brains four major divisions
brain stem
gray matter mediates levels of functions such as,
initiation of voluntary movements
Frontal region
broca's area= speech.
directs voluntary, skeletal actions
influences communication-talking and writing, emotions, intellect, reasoning ability, judgment and behavior
interprets tactile sensations =touch and pain
temperature, shapes, and two point discrimination
influences the ability to read with understanding

primary visual receptor center
receives and interprets impulses from the ear.
contains wernicke's area=interpreting auditory stimuli
To test cranial nerve 1, the nurse would assess the client's ability to ?
If the nurse documents, 20/20 vision OS, 20/20 vision OD, full visual fields intact, red reflex present, optic disc round w. well defined borders. Retinal background is pink. No hemorrhages or arteriovenous nicking noted. What cranial nerve had been asse
cranial nerve 2- vision- sensory.
When assessing cranial nerves 3, 4, and 6, the nurse would document?
No ptosis
full extraocular movements
A present corneal reflex
temporal and masseter muscles contract bilaterally.
able to identify light, sharp, and dull touch to forehead, cheek and chin
is an assessment of what cranial nerve?
cranial nerve 5- trigeminal- sensory and motor
When testing cranial nerve 7 the nurse should assess the clients ability to ?
the clients ability to smile, frown, wrinkle forehead, show teeth, puff out cheeks, pursed lips, raise eyebrows, and close eyes against resistance.
The client will be able to ____________
when the nurse assess cranial nerve 8?
the clients ability to
hear whispered words bilaterally
vibration heard equally well in both ears.
air conduction greater than bone conduction.
Uvula and soft palate rise symmetrically on phonation.
Gag reflex present.
swallows w.out difficulty is an assessment of what cranial nerve?
cranial nerve 9- glossopharyngeal- sensory and motor

cranial nerve 10- vagus- sensory and motor
To assess the cranial nerve 11 (spinal accessory- motor) the nurse would assess the client ability to ?
shrug shoulders against resistance.
Cranial nerve 12 (hypoglossal- motor), the nurse would be assessing the client's ability to ?
protrude tongue in mid-line with no tremors, able to push tongue blade to right and left without difficulty.

CA-I sensory
carries smell impulses from nasal mucous membrane to brain.

CA-II sensory
carries visual impulses from eye to eye.

CA-III motor
contracts eye muscles to control eye movement( inferior lateral, medial, and superior), constricts pupils, and elevates eyelids.

CA-IV motor
contracts eye muscle to control inferomedial eye movement
CA- V sensory and motor
(s) carries sensory impulses of pain, touch, and temperature from the face to the brain.

(m) influences clenching and lateral jaw movements =biting and chewing
controls lateral eye movements
Cranial nerve VII

sensory and motor
(s) contains sensory fibers for taste on the anterior two thirds of tongue and stimulates secretions from salivary glands and tears from the lacrimal gland
(m)supplies the facial muscles and affects facial expressions=smiling, frowning, closing eyes
cranial nerve IX

sensory and motor
(s) sensory fibers for taste on the posterior third of the tongue and sensory fibers of the pharynx that result in the gag reflex when stimulated.
(m)provides secretory fibers to the parotid salivary glands: promotes swallowing movements.
Cranial nerve X
vagus nerve

sensory and motor
(s) carries sensations from the throat, larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera.
(m) promotes swallowing, talking, and production of digestive juices.
Cranial Nerve XI
Spinal accessory

innervate the neck muscles( sternocleidomastoid and trapezius) that promote movement of the shoulders and head rotation. promotes some movement of the larynx.
Cranial nerve XII

innervate the tongue muscles that promote the movement of food and talking.
Dizziness and light-headedness may be related to ?
carotid artery disease, cerebellar abscess, Meniere's disease, or inner ear infection.
Imbalance and difficulty coordinating or controlling movements are seen in ?
neurological diseases involving the cerebellum, basal ganglia, extrapyramidal tracts, or the vestibular part of cranial nerve VIII( acoustic)
A decrease in a clients ability to smell could indicate ?
a dysfunction of cranial nerve I or a brain tumor.
A decreased sense of smell and taste is a normal finding in what group of people?
the elderly
A decrease in the clients ability to taste indicates ?
a dysfunction of cranial nerve VII (facial) or cranial nerve IX (glossopharyngeal)
Ringing in the ears or hearing loss could indicate??
a dysfunction of cranial nerve VIII (acoustic).
Changes in vision could be the cause of ? list 3
a dysfunction of cranial nerve II (optic), increased cranial pressure, or brain tumors.
Double or blurred vision could be the cause of a dysfunction in what cranial nerve?
cranial nerve III (oculomotor, IV (trochlear), or VI (abducens),
Transient blind spots may be an early indictor of ?
cerebrovascular accident (CVA)
The loss of the ability to control bowel functions or urinary retention or bladder distention, functions could indicate?
a spinal cord injury or tumors
Difficulty swallowing may relate to what disorders?
myasthenia gravis
Gullain-Barre syndrome
dysfunction of cranial nerve IX, X, or XII.
Difficulty understanding what is being said by others indicates damage to what area of the brain?
Wernicke's area located within the temporal area of the brain
Difficulty speaking, indicates damage to what area of the brain?
Broca's area located within the frontal area of the brain.
client opens eyes, answers question, then falls back to sleep.
client opens eyes to loud voice, responds slowly with confusion, seems unaware of environment.
client awakens to vigorous shake or painful stimuli but returns to unresponsive sleep...the nurse would note the clients alertness as?
decorticate posture


abnormal flexor posture
wrist and elbows flexed
arms adducted
thighs internally rotated
plantar flexed
decerebrate posture


abnormal extensor position
upper arm adducted
elbows extended
forearm internally rotated
palms pronated
plantar flexed
Clients with lesions of the corticospinal tract.

draws hands up to the chest
decorticate or abnormal flexor posture
Clients with lesions to the diencephalon, midbrain, or pons, extend arms and legs, arches neck, and rotates hands and arms internally when stimulated.
decerebrate or abnormal extensor posture.
GCS score of optimal level of consciousness is ?
a score of 14
a normal posture is ?
relaxed with shoulders and back erect when standing or sitting.
a slumped posture may indicate?
hopelessness or powerlessness characteristics of depression or organic brain disease
Prolonged euphoric laughing is typical of ?
bizarre body movements and behavior may be noted in clients with ?
schizophrenia or a side effect of drug therapy or other activity
meticulous grooming and finicky mannerisms may be seen in ?
obsessive compulsive disorder
poor hygiene, inappropriate dress may be seen in clients with?
Alzheimer's disease
One sided neglect be the result of ?
lesion in the opposite parietal cortex, usually the nondominant side.
cerebellar ataxia
wide based, staggering, unsteady
client cannot stand w. feet together.
seen with cerebellar diseases or alcohol or drug intoxication.
Parkinson's gait
shuffling gait, turns accomplished in very stiff manner.
stooped over posture w. flexed hips and knees.
seen in Parkinson's because of effect on basal ganglion
scissors gait
stiff short gait;thighs overlap each other w. each step.

seen w. partial paralysis of the legs
spastic hemiparesis
flexed arms held close to body while client drags toe of leg or circles it stiffly outward and forward
seen w. lesions of the upper motor neurons in the cortical spinal tract. example stroke
foot drop
cannot flex foot
lifts foot and knee high w. each step
cannot walk on heels
diseases of the lower motor neurons
If a client score less than a ten on the Glasgow's Coma Scale is considered to be
in need of serious medical attention
If a client scores less than a 7 on the Glasgow Coma Scale the client is considered to be ?
in a coma
voice volume disorder

laryngeal disorders or impairment of cranial nerve X (vagus nerve)
abdominal pain that awakens a client at night is associated with ?
duodenal ulcers
Epigastric pain accompanied with tarry stools is associated with ?
gastric or duodenal ulcer
bright hematemesis is associated with ?
bleeding esophageal vacies
ulcer of the stomach or duodenal
Risk factors for CVA
older adult= doubles q.year after 55
male sex
history of TIA
HX of cardiovascular disease
diabetes mellitus
African American
What twelve U.S. states have a higher
incidence of stroke?
North & South Carolina
Washington D.C.
Remote memories may be impaired with what type of disorders ?
cerebral cortex disorders
Tremors are typical in what degenerative neurological disorders?
Parkinson's ( three to six per/sec while muscle at rest.
cerebellar disease and multiple sclerosis( variable rate, especially with intentional movements)
Prescription and nonprescription drugs could cause ?
tremors or dizziness
altered level on consciousness
decreased response times and mood and temperament changes
A stoke results when ?
blood supplies to an area of the brain is disrupted.
What type of movement should be used to test the reflexes?
quick, brisk strike.
How should the nurse hold the handle of the reflex hammer?
between the thumb and index finger
The pointed end of the hammer is used to assess?
to strike a small area
THe wider end of the relfex hammer is used to assess?
blunt or flat end is used to test a wider area or a more tender area.
If reflexes are rated as a 4+ they would be considered?
hyperactive, very brisk, rhythmic oscillation: abnormal and indicate a disorder
If reflexes are rated as a 3+ they would be considered?
more brisk or active than normal, but not indicative of a disorder.
If reflexes are rated as a 2+ they would be considered?
Normal usual response
If reflexes are rated as a 1+ they would be considered?
decreased, less active than normal
If reflexes are rated as a 0 they would be considered?
no response
what reinforcement techniques should be used if testing the arm reflexes?
have the client clench his or her jaw or squeeze the thigh with the opposite hand then strike the tendon.
What reinforcement technique should be used when assessing the reflexes of the legs?
have the client lock the fingers of both hands and pull against them: strike the tendon
Loud, rapid speech could indicate ?
manic phases of bipolar disorder
Slow, repetitive speech is characteristic of ?
Parkinson's disease
Slow repetitive speech
Mask like expression
shuffleing gait
stooped over posture
flexed hips and knees
Parkinson's disease
contains sensory fibers for taste on the anterior two thirds of tongue and stimulates secretions from salivary glands and tears from the lacrimal gland
Trigeminal nerve
To assess the clients recent memory the nurse would ask?
what did you have for breakfast.
something that can be recalled from the last 24 hours.
Signs and symptoms of schizophrenia
Eccentric moods not appropriate to the situation.
poor hygiene or inappropriate dress
bizarre body movements and behavior
repetition of phrases
reduced degree of orientation
inability to compare/contrast items
impaired judgment
(rhythmic oscillation of the eyes)
seen with cerebellar disorders.
constricted fixed pupils could be the result of ?
narcotic abuse or damage to the pons.
inability to close eyes,
wrinkle forehead,
w. paralysis to the lower part of the face on the affected side is associated with ?
Bell's palsy
A corneal reflex may be absent in clients with?
trigeminal nerve or lesions of the motor part of cranial nerve VII.

may be absent or reduced in clients who wear contacts
What is the technique to assess the biceps reflex?
client partially bend arm
nurse places their thumb over the bicep
nurse strikes their thumb with the reflex hammer
test other side
When assessing reflexes what would be an abnormal response?
no response or an exaggerated response
Normal reflex responses are indicated by what numbers?
1+, 2+, or 3+
To test tactile discrimination the nurse would?

have client close eyes
place a familiar object in clients hand
ask client to identify object
repeat on the other side.
To test graphesthesia the nurse would?
have client close eyes.
use a blunt interment to write a number or letter on the palm of the clients hand.
ask client to identify the number or letter.
repeat on the other side
What position should the client be in for the nurse to assess the patellar reflex?
both legs hanging freely off the side of the table or if client cannot sit they can be in the supine position
What reflex may be absent in older clients?
Achilles reflex
How is a complete neurological exam performed?
from the level of higher cerebral integration to the level of lower level of reflex activity.
Mental status examinations provide what type of information?
cerebral cortex functions
the cranial nerve examination provides information concerning?
the transmission of motor and sensory messages primarily to the head and neck.
the motor and cerebellar systems are assessed to determine?
functioning of the pyramidal and extrapyramidal tracts.
the cerebellar system is assessed to determine level of balance and coordination.
the motor system is usually performed with the musculoskeletal system.
the sensory system provides information concerning ?
the integrity of the spinothalamic tract, posterior columns of the spinal cord, and parietal lobes of the brain
When a complete neurological exam is unnecessary the nurse can perform a ?
neuro- check which includes
level of consciousness
pupillary checks
movement/strengths of extremities
sensations in the extremities
vital signs
When is a neuro-check useful?
in an emergency or when frequent assessments are needed during the acute phase of illness, or when a client has already had a complete neurological test.
To test judgement the nurse could ask the client?
what they do when they are in pain.
If meningitis is suspected, the nurse should try to elicit what responses?
the Brudzinski's and Kernig's signs
To elicit a Brudzinski's sign to nurse would follow what steps ?
1. assess that there is not a injury to the cervical vertabral or cervical spine.
2. w. client supine, the nurse flexes the clients neck foward until the chin touches the chest.
3. watch the knees and hips in reaction to the maneuver.
A normal response to the Brudzinski maneuver is?
hips and knees remain relaxed and motionless.
An abnormal response to the Brudzinski's maneuver is= a positive Brudzinski's response.
flexion of the hips and knees and suggest meningeal inflammation
Pain in the neck and resistance to flexion can be the result of ?
meningeal inflammation, arthritis, or neck injury.
Abnormal abdominal reflex
absent due to lower or upper motor neurons
Obesity or muscular stretching from pregnancies can result in an absence in what reflex?
abdominal reflex
Where are superficial reflex receptors located ?
in the skin
To perform the plantar reflex the nurse would?
1. using the end of the reflex hammer.
2. stroke the lateral aspect of the sole from the heel to the ball of the foot curving medially across the ball.
3. the toes should flex: a normal response.
Abnormal involuntary muscular movements ?
unusual bizarre face, tongue, jaw or lip movements
slow, twisting movements in the extremities
brief, rapid, irregular, jerky movements at rest.
are fasciculations a normal or abnormal finding ?
What test should be performed if there is an abnormality in the clients ability to sense light touch and pain?
temperature test
If position sense is intact on the distal body parts than the nurse knows?
it will be intact in the proxiamal areas
If an elderly client reports a decreased sense of position in the great toe the nurse would document this as what type of finding?
If a client cannot correctly identify an object placed or drawn on their palm, or discriminate between two points, or identify areas simultaneously touched, this could indicate???
lesions of the sensory cortex
Reflexes documented as a 4+ could indicate??
seen with clients with lesions of the upper motor neurons and when the higher cortical levels are impaired.
A positive Babinski sign could be the result of ???
lesions of the upper motor neurons
unconscious states resulting from alcohol.
epileptic seizure

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