Chapter 14: Care of the Patient with a Neurologic Disorder

Proprioception

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body?

Hemianopia

Defective vision or blindness in half of the visual field

Valium

Diazepam - used for generalized tonic-clonic and status epilepticus, mixed seizures

Dysphagia

Difficulty swallowing

Patency of airway

During admission of a patient with a severe head injury to the ER, what is the highest priority assessment for the nurse?

Mesantoin

Mephenytoin - used for tonic-clonic, focal and psychomotor seizures

Mysoline

Primidone - used for generalized tonic-clonic, focal and psychomotor seizures

Mestinon

Pyridostigmine Bromide (Cholinesterase Inhibitor) - Inhibits destruction of acetycholine released from parasympathetic and somatic efferent nerves; causes acetylcholine to accumulate, promoting increased stimulation of receptor; is used in myasthenia gravis and by the oral route for senility associated with Alzheimer's disease.

Eldepryl

Selegiline Hydrochloride (MAO-B Inhibitor) - used as treatment adjunct to levodopa and carbidopa-levodopa; may slow Parkinson's disease and need for increased medication; may increase lifespan of people with Parkinson's disease.

Proprioception

Sensation pertaining to the ability to recognize spatial position without looking at it and the ability to objectively know the sense of touch.

Feed self with setup and adaptive equipment

The nurse is caring for a home health patient who had a spinal cord injury at C5 3 years ago. The nurse bases the plan of care on the knowledge that the patient will be able to:

Tetraplegia

The nurse is caring for a patient who suffered a cervical spinal cord injury. What injury can most likely be anticipated?

Check for bladder distention

The nurse is caring for a patient with a spinal cord injury who displays symptoms of autonomic dysreflexia. What intervention should the nurse implement first?

Myelin

The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the _____________.

Topamax, Gabitril, Keppra, Zonegran

Topiramate, tiagabine, levetiraetam, zonisamide - Indicated for partial seizures and for secondary generalized seizures; currently used a adjunctive therapy.

Agnosia

Total or partial loss of the ability to recognize familiar objects or people through sensory stimuli.

Depakene

Valproic acid - used for absence seizures

Flaccid

Weak, soft, flabby; lacking normal muscle tone

12

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement?

Fund of knowledge

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during an LOC assessment?

Signs and symptoms may not occur until several days after the trauma

What is the nurse aware of when assessing a person with a craniocerebral injury?

Restart drugs at a lower dosage with favorable results

What is the purpose of a "drug holiday" in the treatment of Parkinson disease?

Concentration, Wakefulness, Attention & Introspection

What is the reticular activating system (RAS) essential to?

Place the child in respiratory isolation

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis?

Use helmets for bicycles, motorcycles and skateboarding, Use helmets when participating in contact sports, Never drive or ride with someone under the influence of drugs or alcohol & Wear seatbelt and shoulder harnesses when driving or riding in a car.

A nurse in the ER of her community hospital is teaching a group of high school students how to prevent head and spine injuries. What should the nurse include in the presentation?

"This procedure helps prevent a stroke by removing atherosclerotic plaques obstructing cerebral blood flow."

A patient experiencing TIAs is scheduled for a carotid endarterectomy. The patient asks the nurse what this procedure is. The nurse correctly responds with which response?

Cranial Nerve VII

A patient has been diagnosed with Bell's palsy. This condition affects which cranial nerve?

Tuck chin when swallowing

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely?

Second stage

A patient is in which stage of Alzheimer's disease when she demonstrates "sundowning"?

It is not uncommon to lose consciousness during this type of seizure

A 12-year old has a history of generalized tonic-clonic seizures. The nurse educates the patient and his family by including which teaching points?

Kernig's sign

A 13-year old student is admitted to the pediatric unit with possible meningitis. The nurse finds that the patient cannot extend her legs completely without experiencing extreme pain. The nurse correctly documents this as which sign?

Bradykinesia, Tremor & Rigidity

A 76-year old who has had Parkinson's disease for the past 6 years has now been admitted to a long-term care facility. The nurse doing the admission interview and assessment notices which characteristic sign of the disease?

Autonomic Nervous System

transmits messages from the CNS to the smooth muscle, cardiac muscle and certain glands. It's called the "involuntary nervous system" because actions takes place without conscious control; has two divisions sympathetic and parasympathetic.

The are preceded by an aura

Which symptom is specific to migraine headaches?

Promotes nerve impulse transmission

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myastenia gravis?

The disease can rapidly progress into respiratory failure

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately?

"A TIA is often a precursor to a stroke."

A patient is admitted to the hospital with a diagnosis of transient ischemic attack (TIA). The patient asks the nurse to explain to him what a TIA is. Which statement by the nurse is the most accurate?

Nystagmus

Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical or mixed movements, is called __________________.

Nystagmus

Involuntary, rhythmic movement of the eyes

Spastic

Involuntary, sudden movements or muscular contractions with increased reflexes

Efferent (Motor) Neurons

Receive and transmit messages FROM the CNS to muscles and glands in all parts of the body

Afferent (Sensory) Neurons

Receive and transmit messages TO the CNS from all parts of the body.

"Antibodies attacking the acetylcholine receptors, damaging them and reducing their number is the most likely cause of myastenia gravis."

The nurse is caring for a patient with myasthenia gravis. The patient asks the nurse about the causes of the disease. Which response by the nurse is correct?

Maintain the head of the bed at 30 degrees

The nursing care plan for a patient with increased intracranial pressure will include what as the most therapeutic position for the patient?

Visceral sensory nerve

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and carries motor fibers to glands that produce digestive juices?

Inability to wrinkly forehead and pucker lips on affected side

What is the first sign of Bell's palsy?

Plasmapheresis and IV immune globulin

When reviewing the medical plan of treatment for a patient with Guillain-Barre syndrome, which therapies are considered to be most therapeutic?

Increase in systolic b/p, Widening of pulse pressure & Bradycardia

Which sign or symptom of late-stage increased intracranial pressure should the LPN/LVN be aware of?

Trileptal

Oxcarbazepine - used for generalized tonic-clonic and partial seizures

Extremely stressful or frightening event

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Which is the first autonomic event?

3 hours

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in ___ hours of the onset of symptoms to have maximum benefit.

As individual scores in each category

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response and respiration. How are these results reported?

Decrease in the LOC

What is the cardinal sign of increased intracranial pressure in a brain injured patient?

"Can you describe the sensations you are having?"

Which questions is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem?

Namenda

Memantine (N-Methyl-D-Aspartate (NMDA) Receptor Agonist) - to decrease glutamate, which is an excitatory neurotransmitter in the CNS; approved for the treatment of moderate to severe Alzheimer's disease; does not prevent or slow neurodegeneration, but found in clinical studies to slow symptom progression.

Hemiplegia

Paralysis of one side of the body

Thrombolytic such as tPA in the first 3 hours

Which plan of care is considered beneficial for select patients who have experienced as ischemic stroke?

Tremor

The nurse explains that the triad signs of Parkinson disease is: _______________, rigidity and bradykinesia.

Tipping the head toward the unaffected side while swallowing

The nursing assessment of an 80-year old who has had a stroke found that she had difficulty swallowing. A videofluoroscopy with barium was performed to rule out aspiration. The rehabilitation team in the skilled nursing facility determined that she can eat a soft diet with one-to-one supervision. Which action is important to prevent aspiration?

Can understand the spoken word, but cannot speak

What does the nurse know about the stroke patient who has expressive aphasia?

Checking the affected side of mouth for food accumulation, offering small bites of food & adding a thickening agent to liquids

Which of the following techniques are necessary for safely feeding a hemiplegic patient?

"If I miss an occasional dose of the medication, it doesn't matter much."

When teaching a patient with Parkinson's disease, which response would indicate the need for further education?

Yogurt, Caffeine & Marinated foods

Which foods should the person who suffers from migraine headaches avoid?

Neurotransmitters

______________________ is/are responsible for the transmission of impulses between synapses.

Deepening respirations & Cushing's response

A patient was involved in a snowmobile accident. On admission to the ER, he is recieving oxygen and is intubated. His Glasgow Coma Scale score is 6. About 10 minutes after arrival, he is noted to have a widened pulse pressure, increased systolic blood pressure and bradycardia. Which finding indicates to the nurse that late-stage increased ICP is present?

EEG

A patient who has been experiencing recent seizure activity is preparing to have diagnostic testing performed. The HCP has explained that the test will provide a graphic recording of the electrical conduction activities of the brain. The patient understands that which test will be performed?

Left frontal lobe & Motor areas of the right cerebrum

A right-handed patient has right-sided hemiplegia and aphasia from a stroke. What is the most likely location of the lesion?

Symmetrel

Amantadine Hydrochloride (Antiviral) - Treats some cases of Parkinson's disease and drug-induced extrapyramidal reactions, although its action in treatment of Parkinson's disease is unknown.

From the left side

An 83-year old patient has had a stroke. He is right handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him:

Lioresal

Baclofen (Antispasmodic) - Reduces transmission of impulses from spinal cord to skeletal muscles; is antispaticity agent for treatment of spinal spasticity resulting from MS or spinal cord injury.

Cogentin

Benztropine Mesylate (Anticholinergic) - Blocks central cholinergic receptors, helping to balance cholinergic activity in basal ganglia; is indicated in treatment of mild cases of Parkinson's disease and control of extrapyramidal reactions.

Tegretol

Carbamazepine - used for generalized tonic-clonic, psychomotor seizures

Sinemet

Carbidopa-Levodopa (Dopamine Receptor Agonist) - Increases levels of dopamine and levodopamine; is antiparkinsonian agent; improve modulation of voluntary nerve impulses transmitter to the motor cortex (lower dosage is needed than with single-dose therapy; efficiency may increase 75% when carbidopa and levodopa are used in combination)

Klonopin

Clonazepam - used for absence seizures, akinetic, myoclonic and generalized tonic-clonic seizures

Felbatol

Felbamate - used for seizures in children, generalized tonic-clonic seizures in adults; may be used to treat patients whose seizure disorders are refractory to other drugs.

Sensation in lower extremities

Following a myelogram the nurse should include in the postprocedure care assessment for:

Cerebyx

Fosphenytoin Sodium - used for short-term parenteral (IV or IM) in acute generalized tonic-clonic seizures; used for status epilepticus and for preventing and treating seizures during neurosurgery

Neurontin

Gabapentin - used for focal, generalized tonic-clonic seizures in adults

Ataxia

Impaired ability to coordinate movement

Lamictal

Lamotrigine - used for focal, generalized tonic-clonic seizures in adults

Aphasia

Language function is defective or absent because of an injury to certain areas of the cerebral cortex.

Dopar-Larodopa

Levodopa (Antiparkinson) - Antiparkinsonian agent (mechanism of action is unknown); increases balance between cholinergic and dopaminergic activity to allow more normal body movements and alleviate signs and symptoms.

Central Nervous System (CNS)

Made up of the brain and spinal cord

Myclonic Seizure

May antedate tonic-clonic by months or years. May be very mild or may have rapid, forceful movements.

Akinetic Seizure

Not common. Peculiar generalized tonelessness.

Psychomotor (Automatisms, also called Partial Seizures)

Occur at any age. Sudden change in awareness associated with complex distortion of feeling and thinking and partially coordinated motor activity. Longer than absence seizures

Jacksonian-Focal (Local or Partial) Seizure

Occur mostly entirely in patients with structural brain disease. Depends on the site of focus. May or may not be progressive.

Absence Seizure (formerly Petit Mal)

Occurs during childhood and adolescence; frequency decreases as child gets older, rarely continues past adolescence. Sudden impairment in or loss of consciousness with little or no tonic-clonic movement. Occurs without warning; has tendency to appear a few hours after arising or when person is quiet.

Luminal

Phenobarbital - used for generalized tonic-clonic, focal and psychomotor seizures

Dilantin

Phenytoin Sodium - used for generalized tonic-clonic, focal and psychomotor seizures.

Bradykinesia

Slowness of voluntary movements and speech

Cognex

Tacrine Hydrochloride (Cholinesterase Inhibitor) - used for treatment of mild to moderate dementia of Alzheimer's type.

Gently wipe nose with absorbent gauze

The newly admitted patient to the ER after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment?

Neck placed in a neutral position

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure and verbal responses that are slow and unintelligible. What is the most appropriate position for this patient?

Neuron (nerve cell)

basic cell of the nervous system. It's composed of the cell body, the axon and the dendrites.

Hypotension

The nurse assures an anxious family member of a 92-year old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example?

Generalized Tonic-Clonic Seizure (formerly Grand Mal)

Most common seizure. Generalized; characterized by loss of consciousness and falling to the floor or ground if patient is upright, followed by stiffening of the body (tonic phase) for 10-20 sec and subsequent jerking of the extremities (clonic phase) for another 30-40 sec.

Diplopia

Double vision

Dysarthria

Difficult, poorly articulated speech resulting from interference in the control over the muscles of speech

Depakote

Divalproex - used for generalized tonic-clonic and myoclonic seizures

Aricept

Donepezil (Cholinesterase Inhibitor) - Improves cholinergic function by inhibiting acetylcholinesterase; ant-Alzheimer's agent; may temporarily lessen some of the dementia associated with Alzheimer's disease, but does not alter the course.

Shuffle with arms flexed

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to:

Tridione

Trimethadione - used for absence seizures

Computerized devices that guide the surgeon

What are surgical navigational systems?

Loss of neurons, Reduction of cerebral blood flow, Lipofuscin & Decrease in oxygen use

What are the effects of normal aging on the nervous system?

Widened pulse pressure, Bradycardia & Increased systolic blood pressure

What are the three signs of Cushing response?

Central & the Peripheral

What are the two divisions of the nervous system?

Preventing increased intracranial pressure

When caring for a patient who has undergone a craniotomy, what is the primary nursing intervention?

Postictal period

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is the this behavior called?

Agnosia

How would a nurse record the behavior when a patient with Alzheimer's disease attempts to eat using a napkin rather than a fork?

To walk with hands clasped behind back to help balance

How would the nurse instruct a patient with Parkinson disease to improve activity level?

Apraxia

Impairment of the ability to perform purposeful acts; inability to use objects properly.

Periperhal Nervous System

Includes all the nerves that lie outside of the CNS

Hyperreflexia

Increased reflex actions

It is possibly a temporary condition and will clear

A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition?

Paresis

A lesser degree of movement deficit from partial or complete paralysis

Unilateral Neglect

Individual is perpetually unaware of and inattentive to one side of the body

"We will ask you if you have any numbness or tingling in your legs after the procedure."

A 70-year old with back pain is scheduled to have a myelogram in the morning to rule out a pathologic condition of the spine. In preparing him for the procedure, what statement by the nurse is accurate?

Somatic Nervous System

sends messages to the CNS via afferent (sensory) neurons and from the CNS o the skeletal muscles (voluntary) via efferent (motor) neurons.

Myelogram

A ______________ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.

The eye is susceptible to injury if the eyelid does not close

A patient is diagnosed with Bell's palsy as indicated by a feeling of stiffness and a drawing sensation of the face. What is important to teach her about the disease?

Sit upright and check b/p

A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of neck and "goose flesh". What should be the primary nursing intervention based on these assessments?

Obtain an allergy history before the test

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test?

Zarontin

Ethosuximide - used for absence seizures, psychomotor, myoclonic and akinetic seizures

Artane

Trihexyphenidyl Hydrochloride (Anticholinergic) - Blocks central cholinergic receptors, helping to balance cholinergic activity of basal ganglia; is antidyskinetic and antiparkinsonian; controls some mild cases as an adjunct to more potent drugs; controls extrapyramidal reactions caused by drugs.

Brain scan, PET scan, Electroencephalography & MRI

A 35-year old patient is being seen for complaints of headache, which she has experienced for the past month. Her HCP wants to rule out a brain tumor. What diagnostic tests will be most helpful in formulating this diagnosis?

Memory loss that disrupts daily life

What is the basic problem that prompts most of the early signs of Alzheimer's disease?

Encourage self-help behaviors as much as possible, such as feeding, Perform ROM to affected extremities every shift & Implement the use of a communication board for the patient to use as needed.

What nursing interventions should the nurse include in the plan of care for a patient who has had a stroke with right-sided hemiplegia and expressive aphasia?