Brunner Chapter 70 Oncologic and Degenerative Neuro Disorders

An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson's disease?

"Lately he seems to move far more slowly than he ever has in the past."

The nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa for 7 years. what common side effect of Sinemet would the nurse see?

Dyskinesia. Another complication of long-term dopaminergic medication use is neuroleptic malignant syndrome seen by severe rigidity, stupor, and hyperthermia

A patient has just been diagnosed with Parkinson's disease and the nurse is planning the patient's subsequent care for the home setting. What nursing diagnosis should the nurse address?

Risk for injury. Individuals with Parkinson's disease face a significant risk for injury related to the effects of dyskinesia.

A patient with Huntington disease has just been admitted to a long-term care facility. The charge nurse is creating a care plan for this patient. Nutritional management for a patient with Huntington disease should be informed by what principle?

The patient is likely to have an increased appetite. Due to the continuous involuntary movements, patients will have a ravenous appetite. Despite this ravenous appetite, patients usually become emaciated and exhausted.As the disease progresses, patients experience difficulty in swallowing and thin liquids should be avoided.

The nurse is caring for a patient with Huntington disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the patient's plan of care?

Apply deep, gentle pressure around the patient's mouth to aid swallowing and administer phenothiazines

The nurse responds to the call light of a patient who has had a cervical diskectomy earlier in the day. The patient states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action?

Call the surgeon to report the patient's pain. Extrusion of the graft may have occurred, requiring reoperation.

A patient has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The patient has just exhibited seizure activity for the first time. What is the nurse's priority response to this event?

Implement precautions to ensure the patient's safety.

The nurse is assessing a patient with an acoustic neuroma who has been recently admitted to an oncology unit. What symptoms is the nurse likely to find during the initial assessment?

Loss of hearing, tinnitus, and vertigo. An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance.

A patient who has been experiencing numerous episodes of unexplained headaches, vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the patient's vomiting is most consistent with a brain tumor?

The patient's vomiting is unrelated to food intake.

A patient diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the patient's care, the nurse should be aware that the effects of the tumor will primarily depend on what variable?

The specific hormones secreted by the tumor

A patient with suspected Parkinson's disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?

When the patient is resting

A patient newly diagnosed with a cervical disk herniation is receiving health education from the clinic nurse. What conservative management measures should nurse teach the patient to implement? (Select all that apply)

-Sleep on a firm mattress rest for several days -Wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disk herniation. -Hot, moist compresses applied to the back of the neck will increase blood flow

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position to patient in what position?

In a flat side-lying position. After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site.

The nurse in an extended care facility is planning the daily activities of a patient with postpolio syndrome. The nurse recognizes the patient will best benefit from physical therapy when it is scheduled at what time?

In the morning; as fatigue often increases in the afternoon and evening.

While assessing the patient at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the patients' cervical diskectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action

Inform the surgeon of the possibility of a dural leak. Serosanguineous drainage may indicate a dural leak. This constitutes a risk for meningitis.

A patient with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize?

Nutritional assessment. Cachexia is a wasting syndrome of weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite. Consequently, nutritional assessment is paramount.

A male patient with a metastatic brain tumor is having a generalized seizure and begins vomiting. What should the nurse do first?

Turn the patient on his side. The nurse's first response should be to place the patient on his side to prevent him from aspirating emesis

The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response?

Your tumor originated from cells within your brain itself. Primary brain tumors originate from cells and structures within the brain. Secondary brain tumors are metastatic tumors that originate somewhere else in the body

A family member of a patient diagnosed with Huntington disease calls you at the clinic. She is requesting help from the Huntington's Disease Society of America. What kind of help can this patient and family receive from this organization Information about this disease? (Select all that apply)

-Information about the disease -Referrals -Public education

A patient with an inoperable brain tumor has been told that he has a short life expectancy. On what aspects of assessment and care should the home health nurse focus? (Select all that apply)

-Pain control -Management of treatment complications -Assistance with self-care -Administration of treatments

A nurse is planning discharge education for a patient who underwent a cervical diskectomy. What strategies would the nurse assess that would aid in planning discharge teaching?

Care of the cervical collar

A patient has been admitted to the neurologic ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. Which of the following assessment parameters should the nurse include in the initial assessment?

Gag reflex

A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to diagnose spinal cord compression from a tumor, nurse will most likely prepare the patient for what test?

MRI

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patient's ADLs, what goal should the nurse prioritize?

Maximizing the patient's level of function

A patient with Parkinson's disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patient's nutritional needs should be met by?

Semisolid food with thick liquids

A gerontologic nurse is advocating for diagnostic testing of an 81-year-old patient who is experiencing personality changes. The nurse is aware of what factor that is known to affect the diagnosis and treatment of brain tumors in older adults?

The effects of brain tumors are often attributed to the cognitive effects of aging.

A patient with Parkinson's disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond?

Let's explore other options, because laxatives can have side effects and create dependency.

A nurse educator is discussing neoplasms with a group of recent graduates. The educator explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue. The physiologic changes that result can cause what pathophysiologic events? (Select all that apply)

-Increased ICP -Focal neurologic signs -Altered pituitary function -Cerebral edema

A patient who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patient's medication regimen?

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment. The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time.

A patient, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease?

Emotional and personality changes. Huntington disease causes profound changes to personality and behavior. It is a nonmalignant disease

A 25-year-old female patient with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the patient is not receiving treatment for her brain metastases, what is the nurse's most appropriate action?

Ensuring that the patient receives adequate palliative care

A nurse is planning the care of a patient who has been recently diagnosed with a cerebellar tumor. Due to location of this patient's tumor, nurse should implement measures to prevent what complication?

Falls. A cerebellar tumor causes dizziness, an ataxic or staggering gait with a tendency to fall toward the side of the lesion, and marked muscle incoordination.

The nurse is caring for a patient who is scheduled for a cervical discectomy the following day. During health education, the patient should be made aware of what potential complications?

Hematoma at the surgical site resulting in cord compression and neurologic deficit and recurrent or persistent pain after surgery.

A patient with amyotrophic lateral sclerosis is being visited by the home health nurse who is creating a care plan. What nursing diagnosis is most likely for a patient with this condition?

Impaired verbal communication

The nurse is writing a care plan for a patient with brain metastases. The nurse decides that an appropriate nursing diagnosis is anxiety related to lack of control over the health circumstances. In planning of care for patient, the nurse should include what intervention?

Patient will be encouraged to verbalize concerns related to the disease and its treatment.

A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in status would nurse attribute to patient's metastatic brain disease?

Personality changes. Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation, memory loss and confusion, focal weakness, paralysis, aphasia, and seizures.

A patient with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the patient best make known his wishes for care as his disease progresses?

Prepare an advance directive.

A male patient presents at the free clinic with complaints of impotency. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect?

Prolactinoma. Prolactinoma most common pituitary adenoma. In men- impotence, small testicles, low testosterone, low or inappropriately normal FSH/LH. Tx- dopamine agonists, cabergoline and bromocriptine, decrease prolactin and reduce size

The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goal?

Promoting effective communication

The nurse is caring for a patient diagnosed with Parkinson's disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination?

Use of a raised toilet seat