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Rehab Nursing CRRN Review ch. 9

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Kassie clary

on 2 May 2014

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Transcript of Rehab Nursing CRRN Review ch. 9

Rehab Nursing CRRN Review IX
ANATOMY OF THE BRAIN
Parietal lobes-Receive and interpret sensory input
pain
temperature
pressure
size
shape
texture
body image
lt/rt discrimination
spatial orientation

Lobes
Frontal lobe (anterior)
emotions
personality
complex intelligence
cranial nerves
CN I
CEREBRAL HEMORRHAGES
Subarachnoid, Extradural, Subdural
Vessel type-arterial, venous and capillary
Origin-trauma,degenerative
Slow or rapid
Vascular supply of the brain
Internal Carotids-80%
Vertebral Arteries-20%
Neuroanatomy
ANATOMY OF THE SPINAL CORD
Cranial Nerves
Meninges-protective layers
pia mater
arachnoid mater
dura mater
Spaces
subarachnoid
subdural
epidural
Ventricles-CSF found and produced
CSF-protects, carries nutrients
Cerebrum-14 billion neurons, building blocks of cns
pseudounipolar
bipolar
multipolar
Gyri
Sulci
Fissures
Lobes
Hemispheres
Frontal lobe (posterior)
voluntary motor movements
Broca's area
motor components of speech
located in left hemisphere
Injuries to frontal lobes
Emotional lability
Difficulty with executive functions
Personality changes
Difficulty initiating voluntary movement
Broca's aphasia
non-fluent aphasia is an expressive aphasia that is characterized by impairment in forming language or expressing thoughts
comprehension and the ability to conceptualize thoughts is usually not impaired
frustration and anger can result from patients awareness of the deficit
Injuries to Parietal lobes

Indicated by difficulty with lt/rt discrimination, spatial orientation, body image perception, atopognosia-loss of the power of topognosia (ability to correctly locate a senastion)
Occipital lobes- receive and interpret

visual stimuli responsible for depth perception
Temporal lobes-control hearing, taste, smell.This includes the Wernicke's area which enables speech reception and interpretation of sound as words. Controls memory functions.
Injuries to the occipital lobe
Difficulty interpreting visual clues or stimuli
Results in functional blindness
Injuries to temporal lobe
loss of smell
hearing deficits
loss of taste
memory deficits
Wernicke's aphasia
aphasia characterized by fluent speech that does not make sense
Cerebral hemorrhages are classified by:
location
subarachnoid
extradural
subdural
vessel type:
arterial
venous
cappilary
origin:
traumatic
degenerative
bleeds can be slow and occur over a long period of time, or could be rapid in onset
Basil ganglia-deep within the cerebrum associated with motor and learning functions, inhibitory allows steady voluntary movements and suppression of meaningless and unintentional movements
Injury to this system results in dyskinesia
tremors
-rhythmic and purposeless movements that occur at rest and disappear during intentional movements
athetosis
-slow snake like writhing movements of the extremities, face, and neck
chorea
-rapid purposeless jerking movements are often associated with facial grimacing
Limbic system-includes structures in the brain involved in emotion, motivation, and emotional association with memory (hypothalamus)
Injury to this system usually results in a hyperaroused state which is indicated by a persons disinhibited behaviors
Diencephalon-Located between the cerebrum and the mesencephalon. Consists of the hypothalamus, thalamus, metathalamus, epithalamus, and most of the 3rd ventricle.
Thalamus functions as a relay station for some sensory messages particularly pain, touch, and pressure
Helps to distinguish pleasant feelings from unpleasant feelings
Hypothalamus located below the thalamus and forms the floor of the 4th ventricle
Master controller of sympathetic and parasympathetic ANS
Produces two hormones that are stored and produced by the pituitary gland
antidiuretic hormone(diabetes insipidus) and oxytocin(uterine contractions)
Thalamus lesions associated primarily with sensory loss. Thalamic syndrome is a vascular disorder that causes disturbances of sensation and partial or complete paralysis of one side of the body.
Characterized as a nonspecific, spontaneous, intolerable pain that can not be relieved pharmaceutically.
Hypothalamus impairment results in somnolence, coma, anorexia, loss of libido, and endocrine disorders
Brain stem includes:
midbrain, pons, medulla oblongata, and reticular formation. The cell bodies of cranial nerves 3-12 are in the brain stem.
Midbrain
composed of 2 structures :
Substantia nigra-motor nuclei that are concerned with muscle tone. Impaired in people with Parkinson's disease
Red nucleus-large motor nuclei associated with flexor rigidity
Injury in the mid brain is associated with Decorticate posturing
Pons-
a bridge between cerebullar hemispheres. Contains 2 areas that help control breathing.
Apneustic center initiates inspiration
Pneumotaxic center inhibits inspiration
Injury to the pons usually involves abnormal breathing patterns
Central neurogenic hyperventilation-substained regular, rapid deep breaths
Apneustic breathing- substained cramp like inspiratory efforts that pause when inspiration is complete. May also be an expiratory pause.
Comatose patients tested for two reflexes to determine pontine and brain stem involvement.
Oculocephalic reflex (Dolls eyes)- eyes move in sync with head movement
Oculovestibular reflex (Caloric test)-water placed in ear canal, eyes do not deviate toward stimulus
Pontine lesions produce a "locked in" syndrome in which the person has no movement except for the eyelids. The person is conscious, has sensation, and cognition typically intact.
Medulla oblongata-houses the respiratory center
Senses the need to inspire
Exhalation is a passive process
Produces rhythmic breathing
Injury results in ataxic breathing
Controls temperature
Regulates hunger, thirst, and sleep, wake pattern
Swallowing and vomiting centers
Injury results in flaccid muscle tone
Brain Anatomy
Reticular formation
Located in the brain stem
Receives sensory input from all sensory organs
Is associated with controlling states of consciousness
Involves the following functions:
Motor control modulation
Visceral functioning
Sensory filtering
Inhibition of stimuli
Arousal and alertness
Injury to this area may cause coma
Cerebellum
-located below the cerebrum. Involves 2 hemispheres and a medial portion called the vermis
Receives sensory and motor impulses
Responsible for the following:
Coordination of all reflex activity and voluntary motor activity
Regulation of muscle tone and trunk stability
Influence and maintenance of equilibrium
Injury
Deficits on the same (ipsilateral) side of the body as the injury
Hypotonia-decreased resistance to passive movement
Postural changes
Ataxia
Intentional tremors
Jerky movements
Dysmetria-inability to judge movements within space
Dysdiadochokinesis-inability to perform alternating movements rapidly or regularly
Nystagmus disorder or ataxia of the ocular movements
Ataxia of speech muscles (slurred speech)
anatomy of the brain
CN II
CN III
CN IV
CN V
CN VI
CN VII
CN IX
CN X
CN XII
CN XI
CN VIII
Circle of Willis
Formed by the 2 internal carotids and the 2 vertebral arteries
Allows the blood entering the internal carotids to circulate in the brain
May function as a bypass when a major artery is blocked
Base of the skull in the subarachnoid space
Site of congenital aneurysms and anomalies
SPINAL CORD
Begins at the caudal ends at the medulla oblongata and runs to about L1,L2
The conus medularis is the cone shaped area from T10-T12 that ends in the cauda equina that is not part of the spinal cord, but is peripheral nerves
There are ascending and descending tracks afferent/ascending tracks, efferent/descending tracks
review
Please review power point entitled
Spinal Cord Injury
in CRRN folder
Full transcript