Chapter 14.txt

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Chapter 14.txt
2010-02-21 18:28:01
Neurological Disorders

Chapter 14
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  1. What normal change of aging would the nurse expect to see in a 90 year old man with a diagnosis of transient ischemic attack?
    Decreased fine motor coordination
  2. Why diagnostic test is contraindicated for a patient with a suspected brain tumor?
    Lumbar puncture
  3. What would the nurse include in the teaching to prevent head and spine injury?
    Lumbar support for sports activies.
  4. What information is important to share with the pt who is scheduled to have a myelogram to rule out pathology of the spine?
    That the pt will lie completely supine and still during the procedure.
  5. What is important to do to prevent aspiration while eating for a patient who has suffered a stroke?
    Tipping the head toward the unaffected side while swallowing
  6. As a school nurse, what type of information would you give to the classmates of a student who has a history of tonic-clonic seizures?
    That he may cry out at the beginning of a seizure
  7. A pt comes to the ER after a snowmobile accident and presents with a widened pulse pressure, increased systolic blood pressure, and bradycardia. These signs are considered an important diagnostic sign of late stage increased intracranial pressure. Together, what do these signs represent?
    Cushing�s Response
  8. What is a characteristic sign of Parkinson�s disease?
  9. What sign is positive for meningitis and occurs when a pt cannot extend their legs completely without experiencing extreme pain?
    Kernig�s sign
  10. What information is important to teach a patient regarding Bell�s palsy?
    The eye is susceptible to injury if the eyelid does not close
  11. What is the first nursing intervention that is necessary if a patient has autonomic dysreflexia?
    Sit the pt upright, if permitted
  12. When teaching the pt about Parkinson�s disease, what response would indicate the need for further education?
    �If I miss an occasional dose of the medication, it is not of much significance.�
  13. What is the resultant complication if injury to the spinal cord is in the cervical region?
  14. When does a nurse determine that a pt is unconscious?
    Pt only responds to painful stimuli
  15. What is the best way to position a patient with intracranial pressure?
    Maintain the head of the bed at 30 degrees
  16. What is the highest priority on assessment of a pt admitted to the ER with a severe head injury?
    Patency of airway
  17. What is the primary goal of nursing interventions after a craniotomy?
    Preventing increased intracranial pressure
  18. A right-handed pt with right-sided hemiplegia and aphasia resulting from a stroke most likely has a lesion where?
    Left frontal lobe
  19. Why is a carotid endarterectomy done for a pt experiencing TIA�s?
    To prevent a stroke by removing atherosclerotic plaques obstructing cerebral blood flow.
  20. The pathophysiology of mayasthenia gravis is caused by what?
    Antibodies attacking the acetylcholine receptors, damaging them and reducing their number.
  21. Why is a 35 year old man who suffers from tension headaches not given narcotics for the pain?
    Narcotics are avoided due to the risk of abuse
  22. What foods attribute to the cause or worsening of migraine headaches?
    Ripened cheese
  23. What change is a late sign of increased intracranial pressure?
    A widened pulse pressure
  24. What measure may be implemented to reduce venous volume in a pt experiencing increased intracranial pressure?
    Restrict fluid intake; avoid flexion of the hips; administer oxygen
  25. What are the signs and symptoms of late stage increased intracranial pressure?
    Increase in systolic BP; widening of pulse pressure; bradycardia; unequal pupils that react slowly to light
  26. What protective techniques does the nurse teach to pts with potential aspiration problems?
    Chin tuck, double swallow, full Fowler�s position, soft or pureed foods
  27. In what position would the nurse place the pt have a lumbar puncture?
    Side-lying, with legs pulled up and head bent down onto the chest
  28. How does the nurse determine that a client understands postprocedure care after a CT scan with a contrast medium?
    The pt will state that he will drink extra fluids for the day
  29. What trends in vital signs would occur if increased intracranial pressure is rising?
    Increasing temp, decreasing pulse, decreasing respirations, increasing BP
  30. What position would a nurse avoid in a pt with increased intracranial pressure?
    Head turned to the side
  31. The nurse determines that the pt understands the measures to prevent elevations in intracranial pressure if the nurse observes the pt doing what activity?
    Exhaling during repositioning
  32. A pt has clear fluid leaking from the nose following a basilar skull fracture. How does the nurse determine that this is cerebrospinal fluid?
    It separates into concentric rings and tests positive for glucose
  33. A client is admitted to the hospital for observation after an MVA. How long does the nurse leave the cervical collar in place?
    Until the result of spinal x-rays is known
  34. In what position is a pt placed after a craniotomy with a supratentorial incision?
    Head of bed is elevated 30-45 degrees, head and neck midline
  35. A pt with a cervical spine injury has Crutchfield tongs applied in the ER. What would the nurse avoid when planning care for this pt?
    Removing the weights to reposition the client
  36. What are the signs and symptoms of autonomic dysreflexia?
    Severe, throbbing headache
  37. A pt with spinal cord injury suddenly experiences an episode of autonomic dysreflexia. After check vital signs, what should the nurse do immediately?
    Raise the head of the bed and remove the noxious stimulus
  38. What finding is an early indication that the level of consciousness is deteriorating in a pt with an intercranial aneurysm?
  39. What is included as part of the precautions for a client with a cerebral aneurysm?
    Remove the pillow and raise the padded side rails
  40. A nurse is planning care for the pt with hemiparesis of the right arm and leg. The nurse incorporates in the care plan the placement of objects where?
    Within the client�s reach, on the left side
  41. A nurses assesses spinal cord-injured pt who is diaphoretic, with a flushed face and neck, pulse at 40 beats/min, BP is 230/10. What is this client experiencing?
    Malignant hyperthermia
  42. What are the precipitating factors for a pt who has experienced an episode of mayasthenic crisis?
    Omitted doses of medication
  43. What would the nurse plan to do to ensure client safety in the pt who has an impairment of cranial nerve II?
    Provide a clear path for ambulation without obstacles
  44. What is the neurotransmitter that primarily affects motor function and is involved in gross subconscious movements of the skeletal muscles?
  45. What accurately describes age-related changes of the neurologic system?
    As neurons are lost with aging, there is deterioration in neurologic function
  46. What is the term for the condition where a pt with a neurologic disorder is not able to comprehend the written or spoken word?
    Sensory aphasia
  47. What diagnostic test involves the use of differential signal characteristics of flowing blood to evaluate extracranial and intracranial blood vessels?
    Magnetic resonance angiography (MRA)
  48. What is the earliest sign of increased intracranial pressure?
    Change in the level of consciousness (LOC)
  49. What is the appropriate nursing response for a pt who suddenly begins to have a seizure?
    Observe and record the seizure activity
  50. What is the appropriate nursing care for a pt with multiple sclerosis?
    Encourage a well-balanced diet high in fiber and adequate fluids
  51. What is the autoimmune disease of the neuromuscular junction characterized by fluctuating weakness of certain muscle groups?
    Myasthenia gravis
  52. What are the appropriate nursing interventions for the pt with increased intracranial pressure?
    Place neck in neutral position; teach pt to avoid valsalva maneuver; position pt to avoid flexion of hips, wais, and neck; suction only as necessary, no longer than 10 seconds
  53. What is the most common seizure?
    Gran Mal
  54. What are the two stages of a seizure?
    Tonic & clonic
  55. What happens during the tonic stage of a seizure?
    The pt stiffens up
  56. What happens during the clonic stage of a seizure?
    Jerki movements
  57. What is the name of the period after a seizure during which the pt feels groggy and acts disoriented?
    Postictal period
  58. What is the term for a period when seizure activity occurs at such frequency that full consciousness is not regained between seizures?
    Status epilepticus
  59. How is a pt placed during a seizure?
    On their side
  60. What is the term for a sensation as a light or warmth, that may precede an attack of migraine or an epileptic seizure?
  61. What is the most common test used to evaluate seizures?
  62. What are the nursing interventions when caring for a pt during a seizure?
    Observe & record activity; lower pt to floor; don�t restrain; utilize padded side rails; do not leave pt alone
  63. What is multiple sclerosis?
    Chronic, progressive degenerative neurological disease
  64. What are the clinical manifestations of MS?
    Visual problems, urinary incontinence, fatigue, weakness or incoordination, sexual problems, swallowing difficulties
  65. What happens in the body during MS?
    T cells attack the body as if it is an invader
  66. How is MS diagnosed?
    History, clinical manifestations, & sometimes a CT scan
  67. What type of medications are used to treat MS?
    ACTH or steroids to reduce edema and inflammation
  68. What s the function of interferon Beta-1a during the treatment of MS?
    It decreases the frequency of exacerbations & slows the progress of physical disability
  69. What type of diet is recommended for a pt with MS?
    High-fiber & adequate fluids
  70. In what type of environment do people with MS do best?
    Peaceful & relaxed
  71. Why is a urine drug screen completed in the ER?
    To rule out drug use as a cause of lethargy or identify specific drugs used
  72. What happens to glucose & chloride levels of cerebrospinal fluid in a pt with meningitis?
    It lowers
  73. What does an elevated spinal fluid protein indicate?
    Degenerative disease or brain tumor
  74. What does blood in the spinal fluid indicate?
    Hemorrhage in the ventricular system
  75. What type of diagnostic test is used for a pt with a CVA?
    Magnetic resonance angiography
  76. What is evaluated in an MRA?
    Extracranial & intracranial blood vessels
  77. What information is important to obtain from a pt before a rain scan?
  78. What is the purpose of a brain scan?
    To detect pathologic conditions of the cerebrum
  79. When is a lumbar puncture contraindicated?
    In a pt with suspected brain tumor or ICP
  80. How is a pt placed after a lumbar puncture?
    Flat in bed for several hours
  81. What is the function of an electroencephalogram?
    It measures activity levels of the brain
  82. What is a myelogam used to detect?
    Lesions in the intradural & extradural compartments of the spinal canal
  83. What is the most common use for a myelogram?
    Herniated or protruding intervertebral disk
  84. What is monitored in the pt after a myelogram?
    The site of the puncture and strength/sensation of the lower extremities
  85. What is the most common use for an angiogram?
    Detection o an aneurysm
  86. What can be seen in an angiogram?
    The cerebral arterial system
  87. How long is a pt placed after an angiogram?
    On bed rest for 4-6 hours
  88. Why is a carotid duplex used?
    To evaluate carotid occlusive disease
  89. What is the function of an electromyogram?
    It measures the contraction of a muscle in response to electrical stimulation
  90. What is an echoencephalogram?
    An ultrasound to depict intracranial structures of the brain
  91. What is a traction-inflammatory headache?
    Those caused by infection, intracranial or extracranial causes, occlusive vascular structures, and temporal arteritis
  92. How are headaches classified?
    Vascular, tension, traction-inflammatory
  93. What happens to blood vessels during a headache?
    They dilate and become congested
  94. What is the function of ergotamine if taken during a migraine?
    They constrict cerebral blood vessel walls and reduce cerebral blood flow
  95. What type of meds are given for a cluster headache?
  96. What may prevent headaches?
    Regular exercise
  97. What is a migraine?
    A chronic headache preceded or accompanied by aura�s
  98. What is a cluster headache?
    Most painful headache in a cylindrical pattern not triggered by outside forces
  99. What is a tension headache?
    Mild to moderate pain in a band around the head
  100. What does it mean to have intractable pain?
    Pain that is unbearable and does not respond to treatment
  101. As pressure increases within the cranial cavity, how is it compensated?
    Cerebral blood flow decreases and causes inadequate perfusion to the brain
  102. What is the earliest sign of ICP?
    Change in level of consciousness
  103. What happens to vital signs in ICP?
    Increased BP, decreased Pulse, decreased respirations
  104. What is the first, most subtle clue to trouble in ICP?
    Pupils reacting sluggishly
  105. What type of pupil should be reported immediately?
    A blown pupil
  106. What is Cushing�s response?
    Widened pulse pressure, increased systolic BP, & bradycardia
  107. What type of respirations are related to the level of brainstem compression or failure?
    Sterterous or Cheyne-stokes
  108. What is the first step to manage ICP?
    Ensuring adequate oxygenation to support brain function
  109. What three types of medications are used to treat ICP?
    Osmotic diuretics, corticosteroids, and anticonvulsants
  110. How is a pt with ICP placed?
    Head of bed 30-45 degrees to promote venous return
  111. Why is hip flexion avoided in a pt with ICP?
    It causes increased pressure
  112. What medication actually reduces ICP?
  113. How should a pt with ICP breathe when moving?
    They should exhale
  114. What is proprioception?
    The ability to know the position of the body or to be able to identify an object, both without looking
  115. What happens during unilateral neglect?
    An individual is unaware of one side of their body
  116. What is hemianopia?
    Defective vision or blindness in half of the vision field
  117. What can cause aphasia?
    Injury to the frontal or temporal lobes
  118. What is sensory aphasia?
    Inability to comprehend spoken or written words
  119. What is motor aphasia?
    Inability to use expressive speech
  120. What is global aphasia?
    Inability to understand spoken words or to speak
  121. What is dysphagia?
    Difficulty swallowing
  122. What is the function of the Glasgow Coma scale?
    To determine degree of consciousness & predict duration and outcome of a coma
  123. What score is accepted as a definition of a coma?
    8 or less
  124. What is assessed using the Glasgow Coma scale?
    Eye opening, best motor response, best verbal response
  125. What changes occur on the nervous system relating to aging?
    Loss of brain weight & neurons
  126. What causes decreased reflexes in the elderly?
    Decrease in blood supply to the spinal cord
  127. What is the purpose of tucking the chin while eating?
    To prevent aspiration of flood to the lungs
  128. What is Parkinson�s disease?
    A slowing down in the initiation & execution of movement
  129. What causes Parkinson�s?
    Damage or loss to dopamine producing cells
  130. What is dopamine?
    A neurotransmitter essential for controlling posture, support, & voluntary motion
  131. How is Parkinson�s diagnosed?
    Pt history, neurological exam, clinical features
  132. What is the ultimate confirmation of Parkinson�s?
    Positive response to Sinemet
  133. What is bradykinesea?
    Slowness of voluntary movements and speech
  134. What are the characteristics of Parkinson�s?
    Tremor, rigidity and bradykinesea
  135. How should a pt with Parkinson�s sleep?
    On a firm bed without a pillow
  136. What type of diet is indicated for a pt with Parkinson�s?
    High fiber and roughage
  137. What is apraxia?
    Impairment in the ability to perform purposeful acts or to use objects properly
  138. What is myasthenia gravis?
    Autoimmune disease characterized by fluctuating weakness of certain skeletal muscle groups
  139. What causes myasthenia gravis?
    Antibodies attach Ach receptor sites
  140. What are the clinical manifestations in myasthenia gravis?
    Weakness of muscles of the neck, shoulders & hands; dysarthria & dysphagia; double vision
  141. What can exacerbate symptoms of myasthenia gravis?
    Upper respiratory infections, emotional tension, & menstruation
  142. What is the simplest diagnostic test of myasthenia gravis?
    Have the pt look up for 2-3 min; if post for MG, pt won�t be able to keep eyes open
  143. What is another name for ALS?
    Lou Gehrig�s disease
  144. What type of drugs are used to treat MG?
    Anticholinesterase drugs
  145. What happens to cause ALS?
    Motoneurons in the brain stem & spinal cord gradually degenerate
  146. What are the primary symptoms of ALS?
    Weakness of the upper extremities, dysarthria, dysphagia
  147. What drug slows the progression of ALS?
    Riluzole (Rilutek)
  148. What is Huntington�s disease?
    An over production of dopamine
  149. What are the clinical manifestations of Huntington�s disease?
    Writhing, twisting movements of the face, limbs, and body
  150. What type of meds are given to a pt with Huntington�s?
    Antipsychotic, antidepressant, antichorea
  151. What type of diet is indicative in the pt with Huntington�s?
    High calorie: 4,000-5,000/day
  152. What is a stroke?
    A blocked artery of the brain
  153. What is a thrombotic stroke?
    Stroke caused by atherosclerosis
  154. What disease processes can lead to a thrombotic stroke?
    Hypertension & diabetes mellitus
  155. When do symptoms of a thrombotic stroke occur?
    During sleep or upon rising
  156. What causes an emboli stroke?
    Thrombus from the heart travels to the brain
  157. What is a hemorrhagic stroke?
    Bleeding into the brain or the subarachnoid space
  158. What is an aneurysm?
    Dilation of the wall of a blood vessel
  159. What is a TIA?
    Temporary block in the blood flow to the brain
  160. What is the major significance of a TIA?
    It warns of an underlying pathologic condition
  161. What type of pt will be eligible for a carotid endarterectomy?
    Those with occlusions of 70-99%
  162. What is a transluminal angioplasty?
    Insertion of a balloon to open a stenosed artery to increase blood flow
  163. What are the sign & symptoms of a stroke?
    Headache, numbness/tingling, inability to think clearly
  164. What is the primary diagnostic test for a stroke?
    CT scan
  165. Why are fluids restricted in the first few days following a stroke?
    To prevent brain edema
  166. What causes trigeminal neuralgia?
    Degeneration or pressure on the 5th cranial nerve
  167. What are the characteristics of trigeminal neuralgia?
    Knife-like pain in the lips, gums, cheek, forehead, or sides of the nose
  168. What is the treatment of trigeminal neuralgia/
    Absolute alcohol injected into the nerve
  169. What can happen to a pt within 24 hours of a 5th nerve resection?
    They develop cold sores
  170. How should food be presented to the person with trigeminal neuralgia?
    Nothing really hot or cold
  171. What is Bell�s Palsy?
    Inflammation of the 7th nerve
  172. What are the signs & symptoms of Bell�s Palsy?
    Numbness, stiffness, or drawing sensation of the face
  173. What is Guillain-Barre syndrome?
    Inflammation & demyelination of the peripheral nervous system
  174. What are the signs & symptoms of GBS?
    Muscle weakness, tingling & numbness that begin in the legs or feet & move up
  175. How is GBS diagnosed?
    By elimination & CT scan to rule out tumors or a stroke
  176. What happens to cerebrospinal fluid in a pt with GBS?
    Protein levels will be elevated
  177. What meds are used to treat GBS?
    Adrenocortical steroids
  178. What is meningitis?
    Acute infection of the meninges
  179. How is meningitis classified?
    Bacterial or aseptic
  180. What is a Kernig�s sign?
    Inability to extend legs completely without pain
  181. What is Brudzinki�s sign?
    Flexion of the hip & knee when the neck is flexed
  182. What are the clinical manifestations of meningitis?
    Severe headache, stiffness of the neck, irritability, malaise, restlessness
  183. What are then nursing interventions for the pt with meningitis?
    A room that�s dark & quiet
  184. What type of isolation is required for a pt w/meningitis?
    Respiratory isolation
  185. What s the standard for diagnosing West Nile Virus?
    IgM test of the blood or cerebrospinal fluid
  186. What is the treatment for WNV?
    Supportive & aimed at managing symptoms
  187. How is WNV encephalitis treated?
    Steroids, anti-seizure meds & osmotic diuretics
  188. What are open head injuries?
    Resulting from skull fractures or penetrating wounds
  189. What is a closed head wound?
    Concussion, contusion, laceration
  190. When does a subdural hematoma form?
    When venous blood collects below the dura
  191. What are the clinical manifestations of a craniocerebral trauma?
    Reactivity of pupils, level of consciousness
  192. What does a Battle�s sign indicate?
    Fracture of a bone of the lower skull
  193. What should the pt NOT do if there is drainage from their nose after head trauma?
    Cough, sneeze or blow nose
  194. What meds may be given to a pt with a head injury?
    Mannitol, dexamethasone, anti-convulsant
  195. Where are lesions in a pt who is paraplegic?
    Thoracic, lumbar, or sacral segments of the spinal cord
  196. What is a complete cord injury?
    Complete loss of spinal cord function
  197. What is spinal shock?
    Temp paralysis below trauma
  198. What is autonomic dysreflexia?
    Increased reflex actions as a result of a spinal cord injury
  199. In what pt does autonomic dysreflexia most often occur?
    In pt�s with cervical injuries or injuries at the 6th vertebrae or higher
  200. What are the clinical signs of autonomic dysreflexia?
    Severe headaches, bradycardia, hypertension, dilated pupils
  201. What is the most common cause of autonomic dysreflexia?
    Distended bladder or fecal impaction
  202. Why is a high-dose steroid given to a spinal cord trauma pt within the first 8 hours of injury?
    Reduce swelling & prevent paralysis
  203. What diagnostic test is performed 1st in a pt with a spinal cord injury?
  204. What is the Pons?
    Connects midbrain to medulla oblongata means �bridge�
  205. What is LOC?
    earliest/most sensitive indicator that something is changing. Low LOC earliest sign of high intracranial pressure.
  206. What is a common cause of cluster headaches?
  207. What is Agnosia?
    Total or partial loss of the ability to recognize familiar objects or people through sensory stimuli
  208. Guillain-Barre syndrome-Respritory. Difficulty swallowing, breathing, + speaking if cranial nerves VII, IX, + X are involved.
  209. Trauma- hematoma- goose egg bump. Closed head is more sever than open because you don�t know what�s going on. Halo sign- ring around blood (has cerebrospinal fluid)
  210. Neurological Pain- transcutaneous electrical nerve stimulation (TENS) + spinal cord stimulation.
  211. CT Scan- detect pathologic conditions of the cerebrum + spinal cord. 20-30 mins. If done w/out contrast medium. Report: lodine plus seafood allergies.
  212. Brain Scan- pt. is injected w/radioisotope
  213. MRI Scan- #1, used to detect stroke, multiple sclerosis, tumors, trauma, herniation, + seizures. Dx test of choice 4 many neuro diseases.
  214. PET Scan- injection of deoxyglucose w/radioactive fluorine. Shades of color give an indication of the level of glucose metabolism.
  215. Disturbances in muscle tone + motor function- clinical manifestation- muscle tone may be described as flaccid (weak, soft, flabby, + lacking normal muscle tone)
  216. Neurological pain- accupuncture used 4 treatment teaching is an important part of the nursing interventions of the pt.