MedSurg Test 6
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The nurse is discharging a patient admitted with a transient ischemic attack (TIA). For which of the following medications might the nurse expect to provide discharge instructions (select all that apply)?
- B) Enoxaparin (Lovenox)
- C) Dipyridamole (Persantine)
- D) Enteric-coated aspirin (Ecotrin)
Which of the following sensory-perceptual deficits is associated with left-brain stroke (right hemiplegia)?
C) Slow and possibly fearful performance of tasks
Which of the following measures should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis
A) Vigilant infection control and adherence to standard precautions
Infection control is a priority in the care of patients with MS, since infection is the most common precipitator of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in hypotension or fluid volume excess or deficit.
A male patient with a diagnosis of Parkinson’s disease (PD) has been admitted recently to a long-term care facility. Which of the following actions should the health care team take in order to promote adequate nutrition for this patient?
C) Provide small, frequent meals throughout the day that are easy to chew and swallow.
Which of the following nursing diagnoses is likely to be a priority in the care of a patient with myasthenia gravis (MG)?
C) Activity intolerance
The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.
The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium assesses for which of the following intended effects of the medication?
A) Lying quietly in bed
Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution.
When providing community health care teaching regarding the early warning signs of Alzheimer?s disease, which of the following signs would the nurse advise family members to report (select all that apply)?
- B) Losing sense of time
- C) Difficulty performing familiar tasks
- D) Problems with performing basic calculations
- E) Becoming lost in a usually familiar environment
Which of the following statements by the wife of a patient with
Alzheimer’s disease (AD) demonstrates an accurate understanding of her husband’s medication regimen?
A) “I’m really hoping his medications will slow down his mental losses.”
There is presently no cure for Alzheimer’s disease, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.
Which of the following patients may face the greatest risk of developing delirium?
D) An elderly patient who takes multiple medications for various health problems
Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.
The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. Which of the following would be an appropriate nursing intervention for this patient?
C) Encourage isometric quadriceps-setting exercises at least qid.
The nurse is reinforcing general health teaching with a 64-year-old patient with osteoarthritis (OA) of the hip. Which of the following points would the nurse include in this review of the disorder (select all that apply)?
- D) OA is more common with aging, but usually it remains confined to a few joints and does not cause crippling.
- E) OA can be prevented from progressing when well controlled with a regimen of exercise, diet, and medication.
- OA occurs with greater frequency with increasing age, but it usually remains confined to a few joints and can be managed with a combination of exercise, diet, and medication. OA can lead to significant
Which of the following patient statements most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)?
D) “My lower back pain seems to be getting worse all the time and nothing seems to help.”
AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.
Information from PT that would help differentiate a hemorrhagic stroke from thrombotic stroke would be...
sudden onset of severe headache
Endarterectomy is done to
prevent stroke by removing atherosclertoic plaques blocking cerebral blood flow.
Clinical diagnosis of dementia is based on
patient history and cognitivie assessment
Vascular dementia is associated with
cognitive changes secondary to cerebral ischemia
Dementia is defined as a
syndrome characterized by cognitive dysfuntion and loss of memory
Creutzfeldt-Jakob disease is characterized by
memory impairment, muscle jerks and blindness
ORIF is indicated when
adequate alignment cannot be obtained by other nonsurgical methods.
Compartment syndrome should be suspected in pt with humerus fracture when
patient experiences pain when passively extending the fingers
In rheumatoid arthritis the joints are damaged by...
bony ankylosis following inflammation fo the joints and invasion of pannus into the joint causing loss of cartilage.
Pathology of SLE includes
the production of a variety of autoantiboides directed against compnenets of the cell nucleus.
Patients with systemic sclerosis should be taught
strategies for good dental hygeine and moth care, to protect the extremities from heat and cold, maintain joint function and presevre muscle strength, and perform yawning exercises every day.
Injury to blood vessel wall, causing clot and infarction. Associated with HTN and DM. Symptoms may progress in first 72 hours.
Stroke from occlusion of small penetrating artery. Most common in basal ganglia, thalamus, internal capsule or pons. Many are asymptomatic but when symptoms are present they are pure motor hemiplegia, pure senory stroke, contralateral leg and face weakness with arm and leg ataxia and isolated motor or sensory stroke.
occludes cerebral artery resulting in infarction and edema of affected area. Second most common cause of stroke. Most emboli originate in heart-associated with afib, MI, endocarditis, rheumatic heard disease, valvular prostheses and strial septal defects. Rapid occurrence of severe clinical symptoms. Headache, no time to develop collateral circulations. Recurrence common is cause not treated.
15% of all strokes, result from bleeding into the brain tissue, subarachnoid space or ventricles.
bleeding in brain cause by ruptured vessel, 10% of all strokes. HTN is most important cause. Can be cause by coagulation disorders, anticoagulant/thrombolytic drugs, trauma, brain tumors, and ruptured aneurysms. Sudden onset of symptoms including neurologic defects, headache, n/v, decreased LOC and HTN, weakness of one side, slurred speech, deviation of the eyes. Progression due to severe symptoms can include hemiplegia, fixed and dilated pupils, abnormal body posturing, and coma.
Intracerebral hemorrage continued
Thalamic hemorrage results in hemiplegia with more sensory than motor loss. Subthalamic hemorrhage causes problems with vision and eye movements. Cerebellar hemorrhages characterized by severe headache, vomiting, loss of ability to walk, dysphagia, dysarthria and eye movment disturbances. Pons hemorrhage most severe due to affect of basic life functions- characterized by hemiplegia leading to complte paralysis, coma, abnormal body posturing, fixed small pupils, hyperthemia and death.
intracranial bleeding into CSF filled space between arachnoid and pia mater. Cause by rupture of cerebral aneurysm. LOC ranges from alert to coma, focal nuerological defects, n/v, seizures, and stiff neck may occur.
Stroke manifestations: anterior cerebral artery
- Motor and/or sensory deficit (contralateral)
- sucking or rooting reflex, rigiditiy, gait problems, loss of proprioception, fine touch.
Stroke manifestations: Middle cerebral artery
dominant side: aphasia, motor and sensory deficit, hemianopsia.
Stroke manifestations: Posterior cerebral artery
Hemianopsia, visual hallucination, spontaneous pain, motor deficit.
Stroke manifestations: Verterbral artery
cranial nerve deficits, diplopia, dizziness, n/v, dysarthria, dysphagia and/or coma.
Right brain damage sypmtoms
- Left paralysis
- Left sided neglect
- Spatial perceptual deficits
- Deny or minimize problems
- Rapid performance, short attention span
- Impulsive, safety issues
- Impaired Judgement
- Impaired time concepts
Left brain damage symptoms
- Right paralysis
- Impaired speech/aphasias
- Impaired left/right discrimination
- Slow performance, cautious
- Aware of deficits: depression, anxiety
- Impaired comprehension related to language and math
- Nonfluent aphasia, frontal lobe damage
- Short phrases that make sense but take great effort
- Omit small words
- Understands speech of others well
- Aware of deficit, frustrated
- Fluent aphasia, left temporal lobe damage/can be right lobe
- Long sentences with no meaning, unnecessary/made up words
- Difficulty following others' speech
- Often unaware of mistakes
- Non fluent, damage to extensive portions of language area
- Severe communication difficulties
- Damage to different language areas
- Difficulty repeating words and sentences although they are able to speak and understand the meaning of words.
- Difficulty naming objects even though they know what the object is and what its use is.
Effects of stoke on motor function
Impaired mobility, respiratory function, swallowing and speech, gag reflex and self care abilities.
Effects of stroke on communication
- Aphasia: occurs when stroke damages dominant hemisphere.
- Dysarthria: disturbance of muscualr control of pseech. -Problems with pronunciation, articulation and phonation.
Effects of stroke on intellectual function:
- Left brain stroke: memory problems related to language, cautious in making judgements.
- Right brank stroke: impulsive and move quickly.
Difficulty making generalizations in both sides.
Effects on spatial-perceptual alterations
- More likely to be from right sided stroke:
- Parietal lobe- incorrect perception of self and illness
- Pt's erroneous perceptoin of self in space, pt may neglect all input from the affected side ( can be worsened with hemianopsia).
- Agnosia: inablity to recognize objects by sight, touch or hearing.
- Apraxia: inablitily to carry out learned sequential movements on command.
- Pt's may not be aware of deficits.
Stroke diagnostic tests
- CT scan
- CTA - CT angiography
- MRA - MR angiography
Ticlopidine and Clopidogrel (Plavix)
All HCP's and dentists must be informed if either of these drugs are being taken. May need to be dc'd 10-14 days before surgery
- Bilateral pressure at base
- squeezing tightness
- 30min - 7 days
- palpable neck and shoulder muscles, stiff neck, tenderness
- Unilateral, radiating up or down from one eye
- bone crushing
- clusters over perido of 2-12 weeks
- 5min - 3 hr
- flushing or pallor in face
- unilateral lacrimation, ptosis and rhinitis
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