Neurologic Disorders

Optimal medical therapy after a stroke

-Antiplatelet medication (aspirin, clopidogrel) -Statin (atorvastatin or simvastatin) -Antihypertensive (Thiazide diuretic, ACE inhibitor or beta blocker) -For pts with A. Fib: Anticoagulant (Warfarin)

Positioning of patient during acute phase following stroke

-Placing the patient in supine position will optimize cerebral perfusion and enhance blood flow to the brain -The supine position is for conscious patients that have no evidence of dysphagia -The pt that in unconscious and at risk for aspiration is placed in a side-lying with the HOB elevated between 10-30 degrees

Types of Focal Seizures

1) Focal: Retains awareness 2) Focal: Altered awareness

5 subtypes of ischemic stroke

1) Large artery thrombotic 2) Small, penetrating artery thrombotic (lacunar) 3) Cardio embolic 4) Cryptogenic 5) Other

Types of Partial Seizure

1) Simple partial 2) Complex partial

The most common stroke symptoms:

1) Sudden unilateral numbness of the face, arm, or leg 2) Sudden trouble speaking or understanding speech 3) Sudden visual disturbances 4) Difficulty walking, dizziness, or loss of balance/coordination 5) Sudden, severe headache

Types of Generalized Seizure

1) Tonic-Clonic 2) Tonic 3) Clonic 4) Absence 5) Atonic 6) Myoclonic

Thrombolysis with recombinant tPA (Alteplase) is the only FDA approved drug for acute ischemic stroke within a _____ hour window of symptom onset

3

A patient is admitted to the neuroscience unit after experiencing a generalized tonic-clonic seizure in the physician's office. During the admission assessment, the patient has another generalized seizure. The nurse implements which of the following nursing interventions first? A. Turn patient on side, protect airway, protect from injury B. Take vital signs, assess level of consciousness, note the time C. Start an IV of 0.9%NS at KVO, administer IV glucose, restrain extremities D. Insert a bite block, place patient supine, maintain privacy

A

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

A

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

A

Which of the following interventions is most likely to preserve and promote the mobility of a patient with Parkinson disease? A. Implementation of a progressive exercise program B. Health education around energy conservation C. Appropriate use of splints and limb-support devices D. Administration of analgesics on a scheduled basis

A

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

A

Modified Rankin Scale (MRS)

A 0-6 assessment scale used to measure the disability as it related to the patients dependence with daily activities after a stroke -0 = No symptoms -6 = Death

TIA definition

A brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting < 1 hour and without evidence of acute infraction

______ can be prescribed to achieve LDL levels <70 mg/dL

A high dose statin (Atorvastatin)

The most common presenting symptom of a cerebral hemorrhage is?

A severe headache

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

A, B, D

The nurse assess for which cardinal clinical manifestations in the patient with Parkinson's disease? (Select all that apply). A. Rigidity B. Disorientation C. Tremor D. Bradykinesia E. Dementia F. Postural changes

A, C, D, F

What are common clinical manifestations of a left hemispheric stroke

Aphasia, Slow cautious behavior, altered intellectual ability

A patient being cared for on the neurologic unit has a diagnosis of acute ischemic stroke. It has affected the left hemisphere of the patient's brain. The nurse would expect to assess which deficit in this patient? a. Left side of body weakness b. Aphasia c. Left field visual deficit d. Lack of awareness of deficits

B

What aspect of an individual's unhealthy diet is associated with an increased risk of stroke? A. Excess intake of simple carbohydrates B. Excess salt intake C. Protein deficit D. Malnutrition

B

What equipment does the nurse ask the nursing assistant to place in the room of a patient admitted with a seizure disorder? A. EEG machine B. Suction equipment C. Restraints D. Padded tongue blade

B

What initial diagnostic test is recommended to assess for a cerebral bleed? a. MRI b. Noncontrast CT c. CT with contrast d. Cerebral angiography

B

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

B

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

B, C, E, F, H

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B, D

Expressive aphasia affects the _______ area of the brain

Broca's

A patient diagnosed with a stroke is experiencing slurred speech. The nurse would accurately document this finding as which clinical manifestation of stroke? a. Aphasia b. Dysphasia c. Dysarthria d. Apraxia

C

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

C

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________. A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

C

In order to prevent hypoxia, vomiting, and pulmonary aspiration in a patient who is having a seizure, how does the nurse attempt to position the patient? A. Supine B. High Fowler's C. Side-lying D. Prone

C

In order to prevent the development of shoulder pain during recovery from a stroke, which nursing action is best? A. Avoid contact with the patient's weak arm whenever possible B. Avoid taking the patient's blood pressure on the affected arm C. Support the patient's weak arm on a pillow or table D. Let the patient's weak arm hang loose whenever possible

C

When caring for a patient with Parkinson disease, the nurse understands that progressive difficulty with which factor is a primary outcome of this diagnosis? A. Nutrition B. Elimination C. Motor ability D. Effective communication

C

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C

Preferred diagnosing imaging for hemorrhagic stroke

CAT Scan Used to differentiate hemorrhagic vs ischemic Reveals acute bleeding better than MRI

Core infract

Cell death at the site of occlusion

A 73-year-old patient has been diagnosed with ischemic stroke following diagnostic studies. Which medication must be given within a 4.5-hour window of symptom onset to be effective in lysing a clot? a. Heparin b. Coumadin c. Plavix d. Alteplase

D

A patient is admitted for evaluation and treatment of generalized tonic-clonic seizures. Which clinical manifestations does the nurse assess for in this type of seizure disorder? A. Persistent jerking movement of one half of the body B. Unilateral jerking movement of one extremity C. Muscle flaccidity followed by tremors of all extremities D. Stiffening of muscles of arms and legs, followed by jerking movements

D

As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

D

What manifestations will the nurse observe in the patient undergoing a tonic-clonic seizure? a. Jerking in one extremity that spreads gradually to adjacent areas b. Vacant staring and abrupt cessation of all activity c. Facial grimaces, patting motions, and lip smacking d. Loss of consciousness, body stiffening, and violent muscle contractions

D

What would the nurse expect to document in a patient diagnosed with a right hemispheric stroke? a. Aphasia b. Slow, cautious behavior c. Right visual field deficit d. Impulsive behavior

D

Which statement by patient prescribed levetiracetam for a seizure disorder indicates the need for further teaching about this medication? A. "I will not drink any alcoholic beverages." B. "I will wear a medical alert bracelet." C. "I will let my doctor know about all of my prescriptions." D. "I can skip a couple of pills if I have a stomach flu."

D

While assessing a client with Parkinson disease, the nurse identifies bradykinesia when the client exhibits which symptom? a. Muscle flaccidity b. An intention tremor c. Paralysis of the limbs d. Slow spontaneous movement

D

Dysarthria

Difficulty in articulating speech, caused by paralysis of the muscles responsible for producing speech "Slurred speech"

Expressive Aphasia

Difficulty speaking or writing

A client has been diagnosed as having global aphasia. The nurse recognizes that the client will be unable to do perform which action?

Form understandable words and comprehend spoken words

What is the most common motor dysfunction resulting from a stroke?

Hemiparesis (Weakness on one side of the body)

A healthcare provider orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?

Heparin b/c it could increase the bleeding associated with hemorrhagic stroke

What is the most important modifiable risk factor for ischemic and hemorrhagic strokes

Hypertension

Receptive Aphasia

Inability to comprehend spoken or written words

Unknown Seizure

Insufficient evidence to classify focal, generalized or both

Transient Ishemic Attack (TIA)

Involves the same pathophysiologic mechanism outlined in the ischemic cascade, but symptoms are transient (<24 hrs) & there is no evidence of cerebral tissue infraction on follow-up brain imaging

What are the 2 major stroke types?

Ischemic and hemorrhagic

Preferred diagnosis imaging for ischemic stroke

MRI reveals evidence of ischemic stroke much earlier than CAT scan

Dysphagia

One of the most common complications after stroke (Occurs in up to 75% of pts)

Primordial Prevention

Refers to strategies designed to decrease the development of disease risk factors

Primary Prevention

Refers to the treatment of established disease risk factors but for those patients who have not yet had an event

Generalized Seizures

Seizure activity involves both hemispheres -Generally no aura

Focal Seizures

Seizure starts in one area of the brain

Partial Seizures

Seizures begin in a part of 1 hemisphere (typically temporal or frontal lobes)

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient?

Semi-fowlers to promote venous drainage & decrease ICP

What is the first line treatment for migraine headaches?

Serotonin Receptor Agonists (triptans- Imitrex, Amerge, Maxalt, Zomig, Axert) MOA: Vasoconstriction and decrease inflammation

What is the most common type of ischemic stroke

Small Penetrating Artery Thrombotic Stroke

What are the 4 cardinal signs of PD?

T: Tremor R: Rigidity of muscles A: Akinesia/Bradykinesia P: Postural changes

Agnosia's

The inability to recognize previously familiar objects perceived by 1 or more of the senses

Carotid Endarterectomy (CEA)

The removal of an atherosclerotic plaque or thrombus from the ICA to prevent recurrent stroke

Ischemic Penumbra

The surrounding area of affected brain tissue in which blood flow has been reduced This can be salvageable with early treatment (IV alteplase or IV tPA) or with clot retrieval

CNs involved in swallowing

Trigeminal (V) Facial (VII) Glossopharyngeal (IIX) Vagus (X) Spinal Accessory (XI) Hypoglossal (XII)

True/False: Ischemic strokes are more common than hemorrhagic

True

Anticholinergic Meds for PD

Used for controlling tremor by counteracting the action of the NT Acetylcholine -Trihexyphenidyl hydrochloride (Artane) -Benztropine Mesylate (Cogentin)

MAOI Meds for PD

Used in combination with a dopamine agonist to delay the use of Levodopa+Carbidopa. -Selegiline (Eldepryl) -Rasagiline (Azilect) -Zydis Selegiline HCl (Zelapar)

What is the Hunt Hess Scale?

Used to grade patients with SAH to predict surgical mortality -Grade 1-5 (Higher score is associated with a poorer prognosis)

Tricyclic Antidepressant Meds for PD

Used to treat depression; dosing is lower in pts with PD (1/3 to 1/2 the dose)

Dopamine Agonist Meds for PD

Useful in postponing the initiation of Levodopa+Carbidopa, or added to the Levodopa+Carbidopa regimen once it looses effectiveness -Bromocriptine mesylate (Parlodel) -Pergolide (Permax) -Ropinirole hydrochloride (Requip) -Pramipexole (Mirapex)

SSRIs and Atypical Antidepressant Meds for PD

Useful in treating depression but may aggravate symptoms of PD

What is the most common visual impairment after a stroke?

Visual field loss -Homonymous hemianopsia: Loss of half of the visual field

For a patient whose stroke is thought to be cardio embolic (d/t atrial fibrillation), ______ is the most effective treatment to reduce stroke risk

Warfarin

Receptive aphasia affects the ________ area of the brain

Wernicke's

COMT Inhibitor Meds for PD

When given in combination with Levodopa+Carbidopa, they can increase the DOA. COMT inhibitors block an enzyme that metabolizes Levodopa, making more Levodopa available for conversion to dopamine -Entacapone (Comtan) -Tolcapone (Tasmar)

Acquired Seizures

cerebrovascular disease, hypoxemia, fever (childhood), head injury, HTN, CNS infections, metabolic & toxic conditions, brain tumor, drug & alcohol withdrawal, allergies, Alzheimer's

Idiopathic seizures

genetic, developmental defects

Damage to frontal lobe

learning capacity, memory and other higher cortical intellectual functions may be impaired, i.e. Limited attention span, difficulties in comprehension, forgetfulness, and lack of motivation