Neurological Disorders

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mjefferds
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241280
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Neurological Disorders
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2013-10-23 15:38:52
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Neurological
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Ch54 and Neurological NCLEX
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  1. cerebrospinal fluid (CSF) for analysis
    • The adult with normal cerebrospinal fluid has no red blood cells in the CSF. The client may have small levels of white blood cells (0 to 3/mm3). Protein (15 to 45 mg/dL) and glucose (40 to 80 mg/dL) are normally present in CSF.
    • NCLEX
  2. client with a head injury and notes that the client is assuming this posture
    • In decorticate posturing, the upper extremities (arms, wrists, and fingers) are flexed with adduction of the arms. The lower extremities are extended with internal rotation and plantar flexion. Decorticate posturing indicates a hemispheric lesion of the cerebral cortex.
    • NCLEX

  3. client with a diagnosis of meningitis and notes that the client is assuming this posture
    • Opisthotonos is a prolonged arching of the back with the head and heels bent backward. Opisthotonos indicates meningeal irritation
    • NCLEX
  4. decerebrate posturing
    • Extension of the extremities and pronation of the arms
    • NCLEX
  5. complications associated with Bell's palsy
    • Complications of Bell's palsy include abnormal return of nerve function; "crocodile tears" (autonomic fibers reconnect to the lacrimal duct instead of the salivary glands, so the client develops excessive tearing while eating); abnormal facial movements because of reinnervation of inappropriate muscles; and spasms, atrophy, and contractures caused by incomplete motor fiber reinnervation.
    • NCLEX
  6. Alzheimer's disease characteristics
    • Dementia is the hallmark of Alzheimer's disease. Recent memory loss is one characteristic. Others include problems with abstract thinking, problems with speech (not hearing), and difficulty in performing familiar tasks.
    • NCLEX
  7. C5 spinal cord injury spinal shock findings
    • During the period of areflexia that characterizes spinal shock, the blood pressure may fall when the client sits up. The bowel and bladder often become flaccid, may become distended, and fail to empty spontaneously. Bowel sounds would be absent. Accessory muscles of respiration may become areflexic as well, diminishing respiratory excursion and oxygenation.
    • NCLEX
  8. myasthenia gravis exacerbation
    • Because dysphagia is a classic sign of myasthenia gravis exacerbation, observing how a client is able to ingest food is an important assessment.
    • NCLEX
  9. information will the nurse reinforce to the client scheduled for a lumbar puncture
    • Client preparation for lumbar puncture includes obtaining informed consent from the client. No dietary or food restrictions are required before the test. The client is told that the test will take approximately 15 to 60 minutes. The nurse needs to inform the client about the need for bedrest following the test.
    • NCLEX
  10. lumbar puncture position
    The client is assisted into a fetal position at the edge of the bed with the knees drawn up to the chest. This position allows full flexion of the spine and wider spaces between the vertebrae. The nurse should also place a pillow between the client's legs to prevent the upper leg from rolling forward and a small pillow under the client's head to support the spine in a horizontal position.NCLEX
  11. lumbar puncture position immediately after procedure
    For 1 hour after the procedure, the client assumes a prone position if able with a pillow under the abdomen to increase intra-abdominal pressure. This position retards leakage of cerebrospinal fluid. NCLEX
  12. digital subtraction angiography
  13. Agnosia
    • A total or partial loss of the ability to recognize familiar objects by sight, touch, or hearing or to recognize familiar people through sensory stimuli as a result of organic brain damage.
    • Mosby
  14. aneurysm
    localized dilation of the wall of a blood vessel usually caused by atherosclerosis and hypertension or, less frequently, by trauma, infection, or a congenital weakness in the vessel wall. Mosby
  15. aphasia
    an abnormal neurologic condition in which the language function is defective or absent because of an injury to certain areas of the cerebral cortex-Broca's area in the frontal lobe and Wernicke's area in the posterior part of the temporal lobe. Mosby
  16. apraxia
    an inability to carry out learned sequential movements on command, perform purposeful acts or use objects properly
  17. ataxia
    impaired ability to coordinate movement
  18. aura
    a sensation, such as of light or warmth, or emotion, as of fear, that may precede an attack of migraine or an epileptic seizure.
  19. bradykinesia
    slowing down in the initiation and execution of movement
  20. deep brain stimulation DBS
    placing an electrode in either the thalamus, globus pallidus, or subthalamic nucleus and connecting it to a generator placed in the upper chest.
  21. diplopia
    double vision
  22. dysarthria
    difficult, poorly articulated speech that usually results from interference in control over the muscles of speech.
  23. dysphagia
    difficulty swallowing
  24. flaccid
    weak, soft and flabby and lacking normal muscle tone
  25. Glasgow coma scale
    a quick, practical, and standardized system for assessing the degree of consciousness impairment in the critically ill and for predicting the duration and ultimate outcome of coma, particularly with head injuries.
  26. global cognitive dysfunction
    generalized impairment of intellect, awareness and judgement
  27. Guillan-Barre syndrome
    • also called acute inflammatory polyradiculopathy or postinfectius polyneuritis.
    • an acute, rapidly progressing, and potentially fatal form of polyneuritis. Results from a widespread inflammation and demyelination of the peripheral nervous system.
    • Autoimmune reaction involving the peripheral nerves. 
    • Often follows a viral infection, trauma, surgery, viral immunizations or HIV infection.
  28. hemianopia
    defective vision or blindness in half of the visual field
  29. hyperreflexia
    or autonomic dysreflexia
    • -a neurologic condition characterized by increased reflex action.
    • -occurs in patients with cord injuries of the sixth thoracic vertebra or higher and most commonly in patients with cervical injuries.
    • -abnormal cardiovascular response to stimulation of the sympathetic division of th eautonomic nervous system; the condition occurs as a result of stimulation of the bladder, large intestine, or other visceral organs.
    • -signs include: bradycardia, hypertension, diaphoresis, "goose flesh", flushing, dilated pupils, blurred vision, restlessness, nausea, severe headache, nasal stuffiness.
  30. nystagmus
    involuntary, rhythmic movements of the eye: the oscillations may be horizontal, vertical, rotary or mixed
  31. paresis
    a lesser degree of movement deficit from partial or incomplete paralysis
  32. postictal period
    rest period after a seizure
  33. proprioception
    the sensation pertaining to the spatial-position and muscular-activity stimuli originating from within the body or to the sensory receptors that those stimuli activate.
  34. spastic
    involuntary, sudden movement or muscular contraction
  35. stroke
    • -brain attack
    • -abnormal condition of the blood vessels of the brain, characterized by hemorrhage into the brain or the formation of an embolus or thrombus that occludes an artery, resulting in ischemia of the brain tissue normally perfused by the damaged vessels
  36. unilateral neglect
    a condition in which an individual is perceptually unaware of and inattentive to one side of the body
  37. Position post craniotomy
    Semi-Fowlers, head maintained in midline, neutral position to facilitate venous drainage.
  38. Positions post supratentorial craniotomy
    • Semi Fowlers
    • Head midline or nuetral
  39. Position for Lumbar Puncture
    side-lying with legs pulled up to the abdomen with head bend down onto chest.
  40. Trends for increasing ICP
    • Increasing temp
    • Increasing B/P
    • decreasing pulse
    • decreasing respirations
  41. Activities that cause indirect elevation of ICP
    • Increased intrathoracic pressure
    • Increased intra-abdominal pressure
    • Valsalva maneuver
    • coughing
    • sneezing
    • blowing nose
  42. Identifying Cerebral Spinal Fluid
    • separates into bloody and yellow concentric rings
    • tests positive for glucose
  43. S/S of concussion
    • confusion
    • difficulty awakening and speaking
    • one-sided weakness
    • vomiting
    • severe headache
  44. Crutchfield Tongs
    • applied after drilling holes in skull.
    • weight is attached to the tongs, which exert pulling pressure on the longitudinal axis of the cervical spine.
  45. autonomic dysreflexia
    • occurs in client with spinal cord injury above the level of T7
    • severe throbbing headache
    • flushing of face and neck
    • bradycardia
    • sudden severe hypertension
    • triggered by noxious stimulus below the level of injury
  46. Frequent cause of autonomic dysreflexia
    • distended bladder
    • constipation
    • fecal impaction
    • stimulation of the skin from tactile, thermal or painful stimuli
  47. Autonomic dysreflexia nursing actions
    • sit client up in bed
    • remove noxious stimulus
    • bring B/P under control with meds
  48. Aneurysm precautions
    • bed rest
    • head elevated
    • quiet setting
    • No pushing, pulling, sneezing, coughing or straining.
    • No coffee or nicotine
  49. Homonymous hemianopsia
    loss of 1/2 of visual field
  50. Myasthenic crisis
    • undermedication
    • responds to administration of cholinergic drugs
  51. Cranial II nerve
    optic nerve
  52. Cerebellum
    responsible for balance and coordination
  53. Hypothalamus
    controls temp
  54. Typical anti-convulsant medication instructions
    • take daily to keep blood level constant
    • having a serum drug level drawn before AM dose
    • avoid D/C abruptly
    • avoid alcohol
    • avoid OTC
    • avoid activities with alertness/coordination until effects are known
    • good oral hygiene
    • wear a medic alert bracelet
  55. Parkinsonian crisis
    • occurs with emotional trauma or sudden withdrawal of medications
    • exhibits severe tremors, rigidity, bradykinesia, anxiety, diaphoresis, tachycardia and hyperpnea
  56. Opisthotonos
    • prolonged arching of the back with the head and heels bent backward.
    • indicates meningeal irritation
  57. Decorticate posturing
    • upper extremities are flexed with adduction of the arms
    • lower extremities are extended with internal rotation of the plantar flexion
    • indicates a hemispheric lesion of the cerebral cortex
  58. Decerebrate posturing
    • upper extermities are extended stiffly and adducted with internal rotation and pronation of palms
    • lower extremities are extended stiffly with plantar flexion.
    • teeth are clinched
    • back is hyperextended
    • indicates lesion in the brainstem at midbrain or upper pons
  59. Flaccid quadriplegia
    • complete loss of muscle tone and paralysis of all four extremities
    • indicating a completely nonfunctional brainstem
  60. Complications of Bell's palsy
    • abnormal return of nerve function
    • crocodile tears
    • abnormal facial movements
    • spasms
    • atrophy
    • contractures
  61. Early s/s of increased ICP
    • changes in LOC including episodes of confusion and drowsiness
    • slight pupillary changes
    • breathing changes
  62. Acetazolamide
    • carbonic anhydrase inhibitor
    • used to decrease cerebrospinal fluid in client with ISP
  63. selegiline hydrochloride (Eldepryl)
    • antiparkonian
    • increases dopaminergic action, assisting in the reduction of tremor, akinesia and the rigidity of parkinsonism.
  64. Early symptoms of Huntingtons disease
    restlessness, forgetfulness, clumsiness, falls, balance and coordination, vertigo, altered speech and handwriting
  65. oxybutynin (Ditropan)
    • antispasmodic
    • relieves urinary urgency, frequency, nocturia and incontinence
  66. Right (non dominant) hemispheric stroke
    • impulsive behaviors
    • confusion
    • perceptual and spatial disabilities
  67. Post lumbar puncture
    • remain flat 6-24 hours
    • liberal fluid intake
    • check puncture site for redness and drainage
    • monitor clients ability to void
    • monitor clients ability to move the extemities
  68. EEG pre-procedure instructions
    • avoid cola, tea, coffee morning of test
    • wash hair evening before test-no gels, lotions or hairsprays
    • test takes 45 minutes to 2 hours
  69. Tinel's sign
    • used for detecting carpal tunnel syndrome
    • percussing the medial nerve at the wrist as it enters the carpal tunnel
  70. Romberg's test
    • checks for cerebellar functioning related to balance.
    • client stands with feet together and arms at the side and closes eye.
    • loss of balance is positive test result
  71. Meningitis S/S
    • positive Kernig's
    • tachycardia
    • red macular-type rash
    • photophobia
    • severe headache
    • stiffness of neck
    • irritability
    • malaise
    • restlessness

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