Med Surg 3 LPN

Nursing management for multiple Sclerosis The nurse assesses the client's current physical and emotional status to determine any new developments or changes in previously assessed conditions. Identify whether the client has visual problems and emphasize that these may diminish when a remission occurs

. Listen to the client's speech, which may be slurred and difficult to understand. Recommend using a language board or other assistive device if communication is severely affected. Adaptive devices for self-care and feeding may be helpful if the client has hand tremors; the client's weight should be assessed regularly to ensure that there is no significant weight loss. Eventually, the client's food may require blenderization if swallowing is impaired

PT 1.5 to 2.5 times the normal control value or the international normalized ratio value of 2.0 to 3.0 is the desired optimum therapeutic result.

1.5 to 2.5 times the normal control value is the desired optimum therapeutic result

Legal blindness is a condition of impaired vision in which a person has a BCVA that does not exceed

20/200 in the better eye or whose widest visual field diameter is 20 degrees or less

Photophobia

: sensitivity to light.

Cranioplasty

: surgical procedure in which a defect in a cranial bone is repaired using a metal or plastic plate or wire mesh.

Craniectomy

: surgical procedure in which a portion of a cranial bone is removed.

Diskectomy

: surgical procedure in which a ruptured intervertebral disk is removed.

Craniotomy

: surgical procedure in which the skull is opened to gain access to structures beneath the cranial bones.

Postictal phase

: time after a tonic-clonic seizure during which some or all of the following may occur: headache, fatigue, deep sleep, confusion, nausea, and muscle soreness.

A patient with a T-2 injury is in spinal shock. The nurse will expect to observe what assessment finding?

Absence of reflexes along with flaccid extremities.

Visually impaired: condition in which visual acuity is between 20/70 and 20/200 in the better eye with the use of glasses.

Acoustic neuroma: benign Schwann cell tumor that progressively enlarges and adversely impacts cranial nerve VIII, which consists of the vestibular and cochlear nerves.

Terazosin (Hytrin)

Administer drug at bedtime to reduce orthostatic hypotension. Warn to change position slowly. Weigh regularly for evidence of fluid imbalance

A patient in the ER has bruising over the mastoid bone and rhinorrhea. The triage nurse suspects the patient has which type of skull fracture?

Basilar Explanation: An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign) in a basilar skull fracture. Basilar skull fractures are also suspected when CSF escapes from the ears (CSF otorrhea) and the nose (CSF rhinorrhea). A simple (linear) fracture is a break in bone continuity. A comminuted fracture refers to a splintered or multiple fracture line

Astigmatism: visual distortion caused by an irregularly shaped cornea.

Cataract: disorder in which the lens of the eye becomes opaque.

Autonomic Dysreflexia (Hyperreflexia)

Characteristics of this acute emergency are Severe hypertension Slow heart rate Pounding headache Nausea Blurred vision Flushed skin Sweating Goosebumps (erection of pilomotor muscles in the skin) Nasal stuffiness Anxiety

Corneal transplantation: replacement of abnormal corneal tissue with healthy donated corneal tissue.

Corneal trephine: surgical procedure in which a small hole is produced at the junction of the cornea and sclera to provide an outlet for aqueous fluid.

A late sign in ICP IS

Cushings syndrome

Cutaneous triggering: technique in which the client lightly massages or taps the skin above the pubic area to stimulate relaxation of the urinary sphincter.

Dysarthria: difficulty articulating and pronouncing words.

Discuss at least four signs and symptoms and nursing care of the client with increased intracranial pressure.

Early-Drowsiness; difficult to awaken Restlessness Confusion Irritability Glasgow Coma Scale ≥13 Personality changes

Endophthalmitis: disorder in which all three layers of the eye and the vitreous are inflamed.

Enucleation: surgical removal of an eye.

Finasteride

Explain that sexual changes are reversible after drug is discontinued. Inform client that it may take 6 months or longer to achieve full benefit.

Which of the following features should a nurse observe during an ophthalmic assessment

External eye appearance During an ophthalmic assessment, the nurse should examine the external eye appearance and the pupil responses of the patient. A qualified examiner determines the internal eye function, the visual acuity, and the intraocular pressure.

Expressive aphasia: neurologic impairment of a person's ability to speak.

Hemianopia: disorder in which the client is only able to see half of the normal visual field.

Types of seizures

II. Generalized Seizures A. Absence seizures B. Myoclonic seizures C. Clonic seizures D. Tonic seizures E. Tonic-clonic seizures F. Atonic seizures

Intramedullary

Intramedullary: within the spinal cord.

Iridotomy: the removal of a portion of the iris; can be a laser or surgical procedure.

Keratitis: inflammation of the cornea.

Cochlear implant: device that is surgically placed in the inner ear and connected to a receiver in the bone behind the ear to improve hearing.

Labyrinthitis: inflammation of the labyrinth of the inner ear.

Laminectomy

Laminectomy: surgical procedure in which the posterior arch of a vertebra is removed to expose the spinal cord and allow the removal of a herniated disk, tumor, blood clot, bone spur, or broken bone fragment.

Keratoplasty: corneal transplantation.

Macular degeneration: breakdown of or damage to the macula, the point on the retina where light rays converge for the most acute visual perception.

Mastoidectomy: surgical procedure performed to remove diseased tissue from the mastoid process.

Mastoiditis: inflammation of any part of the mastoid process.

Ménière's disease: episodic symptoms created by fluctuations in the production or reabsorption of fluid in the inner ear.

Motion sickness: a form of physiologic vertigo; caused by repeated and constant motion.

Myringoplasty: surgical repair of a perforated eardrum.

Myringotomy: incisional opening of the eardrum to allow drainage, ease pressure, and relieve pain.

Neuralgia

Nerve pain

Seizure Assessment Data

Onset—sudden or preceded by an aura Duration of seizure Behavior immediately before and after Type of body movements Loss of consciousness, for how long Incontinence or not Seizure awareness afterward

Otalgia: sense of fullness or pain in the ears.

Otitis externa: inflammation of the tissue within the outer ear.

Open head injury: trauma to the head in which the scalp, bony cranium, and dura mater (the outer meningeal layer) are exposed.

Otorrhea: leakage of cerebrospinal fluid from the ear.

Otitis media: inflammation or infection in the middle ear.

Otosclerosis: disorder characterized by a bony overgrowth on the stapes that is a common cause of hearing impairment among adults.

Paraplegia: paralysis of both legs resulting from spinal injuries at the thoracic level.

Paresthesia: sensation of numbness and tingling.

Periorbital ecchymosis: condition in which both eyes are blackened; also called "raccoon eyes."

Poikilothermia: condition in which the temperature of the body varies with that of the environment.

Ototoxicity: detrimental effect of certain medications on the eighth cranial nerve or hearing structures.

Presbycusis: hearing loss associated with aging.

Hemiplegia: paralysis on one side of the body.

Receptive aphasia: neurologic impairment of a person's ability to understand spoken and written language.

Terazosin (Hytrin)

Reduce the tone of smooth muscle in the bladder neck and prostatic urethra side effects: Hypotension, dizziness, nausea, urinary frequency, incontinence, edema, fatigue, headache

Neurologic deficit: disorder in which one or more functions of the central and peripheral nervous systems are decreased, impaired, or absent.

Reflex incontinence: disorder in which a client lacks awareness of the urge to void.

Presbyopia: condition in which visual accommodation, the ability to focus an image on the retina, gradually declines with aging as a result of lens inelasticity.

Retinal detachment: disorder in which the sensory layer becomes separated from the pigmented layer of the retina.

Discuss the pathophysiology of seizure disorders and different types of seizures.

Seizure disorders are classified as idiopathic (no known cause) or acquired. Causes of acquired seizures include high fever, electrolyte imbalances, uremia, hypoglycemia, hypoxia, brain tumor, drug abuse, and alcohol withdrawal. Once the cause is removed, the seizures cease. The known causes of epilepsy include brain injury at birth, head injuries, and inborn errors of metabolism. In some clients, the cause of epilepsy is never determined. Seizures represent abnormal motor, sensory, or psychic neural activity. The abnormal neural activity occurs alone or in combination from discharges in one or more specific areas of the cerebral cortex

When the client can resume oral intake after a CVA, individualize the diet according to his or her ability to chew and swallow.

Semisolid and medium-consistency foods such as pudding, scrambled eggs, cooked cereals, and thickened liquids are easiest to swallow. Cold foods stimulate swallowing

Rhinorrhea: (1) clear nasal discharge; (2) leakage of cerebrospinal fluid from the nose.

Spinal fusion: surgical procedure in which two or more vertebrae are immobilized.

Spinal shock: loss of sympathetic reflex activity below the level of injury within 30 to 60 minutes of a spinal injury.

Subdural hematoma: bleeding below the dura mater that results from venous bleeding.

Supratentorial: above the Tentorium: double fold of dura mater in the brain that separates the cerebrum from the cerebellum.

Tetraplegia: paralysis of all extremities due to a high cervical spine injury.

A nurse is collaborating with the interdisciplinary team to help manage a patient's recurrent headaches. What aspect of the patient's health history should the nurse identify as a potential contributor to the patient's headaches?

The patient takes vasodilators for the treatment of angina. Explanation: Vasodilators are known to contribute to headaches.

People experiencing vertigo are most likely to have a peripheral vestibular disorder, such as benign paroxysmal positional vertigo, Ménière's disease, and acoustic neuroma

Treatment of vertigo is based on the cause of the vertigo

Tinnitus: disorder in which a client hears buzzing, whistling, or ringing noises in one or both ears.

Tympanotomy: incisional opening of the tympanic membrane.

Trabeculoplasty: procedure in which a laser beam is directed at the trabecular network in the eye.

Uveitis: inflammation of the uveal tract.

The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. What common side effects of Sinemet would the nurse assesses this patient for?

Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome, characterized by severe rigidity, stupor, and hyperthermia.

Define neurologic deficit.

a condition in which one or more functions of the central and peripheral nervous systems are decreased, impaired, or absent

Brudzinskis sign

assessment finding in which flexion of the neck produces flexion of the knees and hips.

Infratentorial:

below the tentorium (an area between the cerebrum and cerebellum).

Halo sign:

blood stain surrounded by a yellowish stain; highly suggestive of a cerebrospinal fluid leak.

Finasteride (Proscar),

cause the prostate gland to shrink Side effects: Loss of libido, impotence, decreased ejaculate, adverse effects on fetal development

Epilepsy

chronic recurrent pattern of seizures.

Parkinsonism:

cluster of Parkinson-like symptoms that develop from several etiologies.

Demyelinating disease:

disorder that causes permanent degeneration and destruction of myelin.

Diplopia:

double vision.

Ptosis:

drooping of the eyelids.

Dysphagia: impaired ability to swallow.

expressive dysphasia

Opisthotonos:

extreme hyperextension of the head and arching of the back.

Glaucoma: eye disorder caused by an imbalance between the production and drainage of aqueous fluid.

hordeolum: inflammation and infection of the Zeis or Moll gland, a type of oil gland at the edge of the eyelid.

Hyperopia: farsightedness; people who are hyperopic see objects that are far away better than objects that are close.

hypopyon intraocular lens (IOL) implant: artificial lens that is inserted in the eye to improve or restore vision.

Name four infectious or inflammatory diseases that affect the central or peripheral nervous system.

meningitis, encephalitis, Guillain-Barré syndrome, and brain abscess

Discuss three neuromuscular disorders, common related problems, and nursing management.

multiple sclerosis (MS), myasthenia gravis, and amyotrophic lateral sclerosis (ALS)—all of which are chronic and progressively debilitating.

Chronic traumatic encephalopathy:

neurodegeneration caused by repeated concussions.

The most common symptoms of stroke include

numbness or weakness of the face, arm, or leg, especially on one side of the body; confusion or change in mental status; trouble speaking or understanding speech; visual disturbances; difficulty walking, dizziness, or loss of balance or coordination; and sudden, severe headache.

Foramen magnum

opening in the lower part of the skull through which the upper part of the spinal cord connects with the brain and which provides the only extracranial exit for brain tissue.

Nuchal Rigidty

pain and stiffness of the neck and an inability to place the chin on the chest

Cheyne-Stokes respirations:

pattern of respiration in which shallow, rapid breathing is followed by a period of apnea.

Chemonucleolysis:

procedure in which the enzyme chymopapain is injected into the nucleus pulposus to shrink or dissolve a ruptured intervertebral disk and relieve pressure on spinal nerve roots.

Contrecoup injury:

result of trauma to the head from force that is strong enough to send the brain ricocheting to the opposite side of the skull, resulting in dual bruising.

Convulsion:

seizure characterized by spasmodic contractions of muscles.

Aura

sensation, either of weakness, numbness, or a hallucinatory odor or sound, that occurs immediately before a generalized tonic-clonic seizure.

Papilledema:

swelling of the optic nerve.

In spinal shock,

the reflexes are absent, BP and heart rate fall, and respiratory failure can occur. Hypovolemia, hemorrhage, and hypertension do not cause this sudden change in neurologic function

For clients with CVA STROKE, To minimize the volume of food needed, provide nutritionally dense foods such as

thickened commercial beverages, fortified puddings, fortified cooked cereals, and scrambled eggs.

Cushing's triad:

three signs associated with an increase in intracranial pressure: pulse that increases initially but then decreases, systolic BP that rises with a widening pulse pressure, and a respiratory rate that is irregular.

If ambulation is impaired, the client may find a wheelchair or other device to be useful temporarily. Safety is a real issue for clients as their mobility becomes less stable. The nurse may identify techniques for managing constipation with high-fiber food and fluids. Bladder elimination may be controlled with intermittent catheterization, inserting an indwelling catheter, or creation of a cystostomy

. Skin care and position changes are implemented to avoid pressure sores. The nurse provides instruction concerning drug therapy, which often facilitates a remission of unknown duration or reduction in the rate of relapse. The nurse or family may be referred to a social worker to determine if the client qualifies for Social Security disability benefits.

Battle's sign

: bruising of the mastoid process behind the ear

Discuss the pathophysiology of seizure disorders and different types of seizures.

In some clients, the cause of epilepsy is never determined. Seizures represent abnormal motor, sensory, or psychic neural activity. The abnormal neural activity occurs alone or in combination from discharges in one or more specific areas of the cerebral cortex

Nursing management seizure disorder

In the event that a seizure occurs, the nurse positions the client on his or her side and loosens restrictive clothing. The airway is kept patent; the client is suctioned, and oxygen is administered. The mouth is inspected for injuries to the tongue, teeth, and buccal cavity. If the client is incontinent, the nurse cleans the client and changes clothing and bed linen. Documentation includes the situation that preceded the seizure to assist in identifying any precipitating factors or aura, the duration of the seizure, parts of the body involved, vital signs, oxygen saturation, and capillary blood glucose level if indicated.

(see full question) A female patient is diagnosed with a right-sided stroke. The patient is now experiencing hemianopsia. How might the nurse help the patient manage her potential sensory and perceptional difficulties?

Place the patient's extremities where she can see them. The patient with homonymous hemianopsia (loss of half of the visual field) turns away from the affected side of the body and tends to neglect that side and the space on that side; this is called amorphosynthesis. In such instances, the patient cannot see food on half of the tray, and only half of the room is visible. It is important for the nurse to remind the patient constantly of the other side of the body, to maintain alignment of the extremities, and if possible, to place the extremities where the patient can see them. Patients with a decreased field of vision should be approached on the side where visual perception is intact. All visual stimuli (clock, calendar, and television) should be placed on this side. The patient can be taught to turn the head in the direction of the defective visual field to compensate for this loss. Increasing the natural or artificial lighting in the room and providing eyeglasses are important in increasing vision. There is no reason to keep the lights dim

Nursing management for ALS

The nurse performs a comprehensive assessment and develops a plan of care based on the client's identified problems. During the early stages of ALS, the nurse provides assistance with walking, bathing, shaving, and dressing. As ALS progresses, the client becomes totally dependent on the family or healthcare personnel for care. The nurse teaches family members required skills, such as suctioning techniques, how to administer tube feedings, and catheter care.

A patient is recovering from intracranial surgery performed approximately 24 hours ago and is complaining of a headache that the patient rates at 8 on a 10-point pain scale. What nursing action is most appropriate

The patient usually has a headache after a craniotomy as a result of stretching and irritation of nerves in the scalp during surgery. Morphine sulfate may also be used in the management of postoperative pain in patients who have undergone a craniotomy.

American sign language: method of communication that uses a hand-spelled alphabet and word symbols.

benign paroxysmal positional vertigo (BPPV): brief periods of severe vertigo when clients move their heads, particularly if they move their head back and toward the affected ear.

Seizure:

brief episode of abnormal electrical activity in the brain.

Status epilepticus:

condition marked by a series of tonic-clonic seizures in which the client does not regain consciousness between seizures.

Parkinson's disease is associated with decreased levels of

dopamine resulting from degeneration of dopamine storage cells in the substantia nigra in the basal ganglia region of the brain

Contusion

: (1) soft tissue injury resulting from a blow or blunt trauma; (2) injury to the head that leads to gross structural injury to the brain and results in bruising and, sometimes, hemorrhage of superficial cerebral tissue.

Autoregulation

: ability of the brain to provide sufficient arterial blood flow despite rising intracranial pressure.

Intracerebral hematoma

: bleeding within the brain that results from an open or closed head injury or from a cerebrovascular condition such as a ruptured cerebral aneurysm.

Cerebral hematoma

: bleeding within the skull that forms an expanding lesion.

Epidural hematoma

: bleeding within the skull that stems from arterial bleeding, usually from the middle meningeal artery, with blood accumulation above the dura.

Kernig's sign

: inability to extend the leg when the thigh is flexed on the abdomen.

Discuss the nursing management of clients with seizure disorders. The nurse asks if the client has a history of seizures, the type and pattern of the client's seizure activity, and the current treatment regimen. If the client has no history of seizure, the nurse identifies clients who may be seizure prone.

For example, a person who has a high fever, has suffered a recent head injury, is withdrawing from alcohol, or is experiencing hypoglycemia or hypoxia is at risk for having a seizure. The nurse modifies the environment to promote safety if a seizure should occur by placing suction, oral airway, and oxygen equipment at the bedside; padding the side rails and head board; and maintaining the bed in a low position. Prescribed anticonvulsant therapy is administered, and the nurse reinforces the importance of drug compliance following discharge.

The nurse should monitor for which of the following manifestations in a patient who has undergone LASIK?

Halos and glare After LASIK surgery symptoms of central islands and decentered ablations can occur which include monocular diplopia or ghost images, halos, glare and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or sty formation

Decreasing level of consciousness (LOC) is one of the earliest signs of increased ICP

Headache is another symptom of increased ICP. Headache, which is more severe in the morning, increases with activities that elevate ICP, such as coughing, sneezing, or straining at stoo

Types of seizures

I. Partial (Focal) Seizures A. Partial seizures (no loss of consciousness) 1. Motor symptoms 2. Special sensory symptoms 3. Autonomic symptoms 4. Psychic symptoms B. Complex partial seizures (with loss of consciousness) 1. Begins as a partial seizure and progresses to complex partial with loss of consciousness 2. Loss of consciousness at onset of seizure II. Generalized Seizures A. Absence seizures B. Myoclonic seizures C. Clonic seizures D. Tonic seizures E. Tonic-clonic seizures F. Atonic seizures

(see full question) Which of the following is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?

Multiple sclerosis Explanation: The cause of MS is not known and the disease affects twice as many women as men. Parkinson's disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

Discuss the nursing management of clients with brain tumors.

Nursing management depends on the area of the brain affected, tumor type, treatment approach, and the client's signs and symptoms. If the tumor is inoperable or has expanded despite treatment, increased ICP is a major threat, Clients who receive chemotherapy and radiation are supported through the adverse effects associated with antineoplastic drug administration and effects of radiation. The nurse clarifies the client's and family's questions concerning treatment modalities and directs the client to appropriate professionals to discuss treatment alternatives. The nurse explains hospice care and services to clients with brain tumors that no longer are at a stage where they can be cured.

During assessment of a patient who has been taking Dilantin for seizure management for 3 years, the nurse notices one of the side effects that should be reported. What is that side effect?

Side-effects of Dilantin include visual problems, hirsutism, gingival hyperplasia, arrhythmias, dysarthria, and nystagmus.

Speech reading: perception of conversation by following the movements of a speaker's lips.

Stapedectomy: surgical procedure to improve hearing loss in which all or part of the stapes is removed and a prosthesis is inserted.

Automatisms

inappropriate, automatic, repetitive movements such as lip smacking and picking at clothing or objects.

Concussion:

injury resulting from a blow to the head that jars the brain and results in diffuse and microscopic injury to it

Cushing's triad

is manifested by bradycardia, hypertension, and bradypnea. elevated systolic blood pressure with wide pulse pressure, irregular breathing.

FOR CVA, When a normal diet is resumed, encourage the client to eat "heart healthy"—

less saturated and trans fats and more fruits, vegetables, and whole grains. Encourage overweight clients to lose weight to reduce cardiac workload. Sodium restriction is appropriate for clients with hypertension.

Bradykinesia

slowness in performing spontaneous movements.

Aneurysm:

stretching and bulging of an arterial wall, usually caused by weakening of the vessel.

Diazepam (Valium), a tranquilizer, is used for its twofold effect:

to reduce anxiety associated with the pain of a herniated disk and to relax the skeletal muscle.

Choreiform movements:

uncontrollable writhing and twisting of the body.

Autonomic dysreflexia

: exaggerated sympathetic nervous system response resulting from a spinal cord injury above T6. Characteristics include severe hypertension, slow heart rate, pounding headache, nausea, blurred vision, flushed skin, sweating, goose bumps, nasal stuffiness, and anxiety.

Closed head injury

: injury to the head in which an intact layer of scalp covers the fractured skull.

Fasciculations:

: involuntary twitching of muscles.

Extramedullary

: outside the spinal cord.

Bruit

: purring or blowing sound caused by blood flowing over the rough surface of one or both carotid arteries.

For a patient with an SCI, why is it beneficial to administer oxygen to maintain a high partial pressure of oxygen (PaO2)?

Because hypoxemia can create or worsen a neurologic deficit of the spinal cord Explanation: Oxygen is administered to maintain a high partial pressure of arterial oxygen (PaO2), because hypoxemia can create or worsen a neurologic deficit of the spinal cord.

The patient has been diagnosed with aphasia after suffering a stroke. What can the nurse do to best make the patient's atmosphere more conducive to communication?

The inability to talk on the telephone or answer a question or exclusion from conversation causes anger, frustration, fear of the future, and hopelessness. A common pitfall is for the nurse or other health care team member to complete the thoughts or sentences of the patient. This should be avoided because it may cause the patient to feel more frustrated at not being allowed to speak and may deter efforts to practice putting thoughts together and completing a sentence. The patient may also benefit from a communication board, which has pictures of commonly requested needs and phrases. The board may be translated into several languages.

Gamma-knife radiosurgery

: noninvasive alternative for treating brain tumors deep within the brain or for treating those tumors that conventional surgery can only partially remove.

Preictal phase

: time immediately before a tonic-clonic seizure consisting of vague emotional changes, such as depression, anxiety, and nervousness.

Coup injury

: trauma to the brain caused when the head is struck directly.

Nystagmus

: uncontrolled oscillating movement of the eyeball.

The nurse is caring for a patient whose recent health history includes an altered LOC. What should be the nurse's first action when assessing this patient?

Assessment of the patient with an altered LOC often starts with assessing the verbal response through determining the patient's orientation to time, person, and place. In most cases, this assessment will precede each of the other listed assessments, even though each may be indicated

Nursing Management of Parkingsons disease

Clients with parkinsonism are admitted to the hospital because of the debilitating effects of the disease. Others are cared for in extended care facilities when they can no longer be managed at home in a chronic state. One of the biggest nursing challenges is managing the client's drug therapy. Levodopa is associated with periods of "breakthrough" or "end-of-dose wearing off" in which symptoms are exacerbated when a consistent drug level is not maintained. The nurse must administer the drugs closely to the schedule the client previously established at home. Over time, clients may decreasingly respond to their standard drug therapy and have more frequent "off episodes" of hypomobility in which they may be unable to rise from a chair, speak, or walk. The drug apomorphine (Apokyn), which was recently approved for these episodes, promises help in relieving this phenomenon. Drugs administered for parkinsonism can cause a wide variety of adverse effects, which requires careful observation of the client. The nurse works with physical and occupational therapists to increase the client's level of activity, optimize his or her gait, improve balance and coordination, and use adaptive equipment to perform ADLs.

A provider prescribes a disease-modifying drug for a patient with relapsing-remitting MS. The nurse advises the patient that the drug has to be taken subcutaneously on a daily basis, and it may take 6 months for evidence of any response. Which of the following is the medication most likely prescribed in this scenario?

Copaxone Copaxone reduces the rate of relapse in the RR course of MS. It decreases the number of plaques noted on MRI and increases the time between relapses. Copaxone is administered subcutaneously daily. It acts by increasing the antigen-specific suppressor T cells. Side effects and injection site reactions are rare. Copaxone is an option for those with an RR course; however, it may take 6 months for evidence of an immune response to appear

Uncal herniation: shifting of the brain to the lateral side.

Credé's maneuver: technique in which the client bends at the waist or presses inward and downward over the bladder to increase abdominal pressure and facilitate emptying the bladder.

Diplopia: double vision.

Emmetropia: normal vision, in which light rays are bent to focus images precisely on the retina.

Collateral circulation: circulation formed by smaller blood vessels branching off from or near larger occluded vessels.

Endarterectomy: surgical removal of the atherosclerotic plaque lining an artery.

Discuss at least four signs and symptoms and nursing care of the client with increased intracranial pressure.

Late- Unresponsive Glasgow Coma Scale ≤12 Decreased response to painful stimuli Decorticate or decerebrate posturing Increased weakness or hemiparesis Dilated pupil(s) Seizures Cushing's triad: bradycardia, elevated systolic blood pressure with wide pulse pressure, irregular breathing

The nurse develops an individualized teaching plan that addresses the following components: Brain tumor

Medication regimen Appointments for chemotherapy or radiation therapy Adverse effects of chemotherapy or radiation and techniques for managing them Nutritional support Home care considerations Rehabilitation (exercises, physical therapy) Referrals to support services for physical, emotional, and financial assistanc

Myopia: nearsightedness; people who are myopic hold things close to their eyes to see them well.

Photophobia: sensitivity to light.

NUrsing management for Myathenis gravis

The nurse provides periods of rest for the client to promote restoration of strength. In addition, the nurse supports ventilation by elevating the head of the bed and suctioning secretions that cause difficulty in swallowing for the client. The nurse also makes an effort to understand the client's efforts at communication during periods when the disease compromises intelligible speaking. The nurse demonstrates patience and empathy to help the client deal with changes in appearance, function, and lifestyle. The effects of drug therapy are observed, especially when first initiated or at times of stress. The nurse must administer medications at the exact intervals ordered to maintain therapeutic blood levels and prevent symptoms from returning. He or she observes for signs of drug overdose, such as abdominal cramps, clenched jaws, and muscle rigidity, which indicate that the dose is excessive.