Med Surg II: Exam 1

CN VI

Abducens

treatment for cholinergic crisis?

Atropine or benzodiazepines (Diazepam)

BE FAST

Balance Eyes Face Arms Speech Time

what diagnostic scan is done for stroke patients?

CT without contrast to look for bleeding

what diagnostic testing is performed to determine brain death?

EEG

CN VII

Facial

CN IX

Glossopharyngeal

causes of viral (aseptic) meningitis?

HSV-2, VZV, mumps, HIV

CN XII

Hypoglossal

what meds are used to immediately halt status epilepticus?

IV valium or ativan

equation for CPP

MAP-ICP = CPP

chronic degenerative progressive disease of the CNS that is characterized by the occurrence of small patches of demyelination in the brain and spinal cord?

Multiple sclerosis

abortive migraine medication

NSAIDs triptan preparations Acetaminophen ergotamine preparations Beta-blockers calcium channel blockers isometheptene combinations anti-epileptic drugs

treatment for myasthenic crisis?

Neostigmine

CN II

Optic

early diagnostic test for HSV-1 encephalitis?

PCR test

signs & symptoms of cholinergic crisis

SLUDGE: salivation, lacrimation, urination, diarrhea, gastrointestinal distress (cramping), emesis

CN V

Trigeminal

CN IV

Trochlear

CN X

Vagus

symptoms of myasthenia gravis are the result of what?

a lower motor neuron lesion

a patient is in spinal shock. what findings do you expect to see?

absence of reflexes and flaccid extremities

myasthenia gravis occurs when antibodies attack which receptor sites?

acetylcholine

what is the earliest sign of deterioration in patients post hemorrhagic stroke?

alteration in LOC - mild drowsiness, slight slurring of speech, and sluggish papillary reaction.

what serious side effect is possible with tensilon?

cardiac dysrhythmias and cardiac arrest

interventions for intracranial hemorrhage

carefully administer fluid, electrolytes and antihypertensives prepare for possible surgery

what is the first step in assessing patients LOC?

checking their verbal response through orientation to person, place, time and situation

when tensilon exacerbates paralysis it indicates what?

cholinergic crisis

what are the three essentials to brain death

coma absence of brainstem reflexes apnea

Trochlear nerve

controls downward and inward eye movement have pt look up, down and inward; ask pt. to follow your finger as you move it towards their face

abducens nerve

controls parallel eye movement (moving laterally) have pt. look up, down and inward; ask pt. to follow your finger as you move it towards their face

spinal accessory nerve

controls strength of neck & shoulder muscles ask pt. to rotate their head and shrug their shoulders

what physiological phenomenon occurs with Parkinson's disease?

decreased availability of dopamine

what medication is used to reduce edema around a brain tumor?

dexamethasone

what finding occurs post-craniotomy?

diabetes insipidus - extreme polyuria

reason for myasthenic crisis?

didn't taken enough of their medication

what are common ocular symptoms in patients with myasthenia gravis?

diplopia and ptosis (dropping of the eyelids)

expected findings in myasthenia gravis patient?

dipoloplia (double vision) & ptosis (drooping of upper eye lid)

which medication is used in the diagnosis of myasthenia gravis?

edrophonium (Tensilon)

a client is diagnosed with a frontal lobe abscess. Which nursing intervention is appropriate?

initiate seizure protocol

what do fixed and dilated pupils indicate?

injury at midbrain level

IADLs

instrumental activities of daily living

brain death

irreversible loss of all functions of the brain, including the brainstem

following a CVA, the nurse is teaching the patient to contract and relax her muscles while keeping her extremity in a fixed position. which type of exercise is the patient performing?

isometric

which of the following are signs of impeding death in a patient following a severe accident? signs of internal bleeding dry mucous membranes hemiplegia loss of brain stem reflexes

loss of brain stem reflexes - pupillary, corneal, gag and swallowing reflexes

S, M or B: CN III (Oculomotor)

motor

S, M or B: CN XII (Hypoglossal)

motor

which of the following is a CNS disorder? a. multiple sclerosis b. guillain-bare c. myasthenia gravis d. bell's palsy

multiple sclerosis

when tensilon improves muscle strength, it indicates what?

myasthenic crisis

nursing interventions for myasthenia gravis

respiratory support - manually assisted coughing, pulmonary hygiene, suctioning, oral care plasmapharesis or IVIG Pharmacological - antiocholinesterases/cholinesterase inhibitors (Pyridostigmine) or cholinergic drugs; immunosuppressive drugs, corticosteroids, plasmapharesis improving function - assisting with ADLs surgery supportive care

Olfactory Nerve

sense of smell have pt close their eyes and use each nostril to check for sense of smell

S, M or B: CN I (Olfactory)

sensory

S, M or B: CN II (Optic)

sensory

S, M or B: CN VIII (Vestibulocochlear)

sensory

dysarthria

slurred speech

hypophonia

soft speech

signs & symptoms of autonomic dysreflexia

sudden, significant rise in blood pressure, bradycardia, severe headache, nasal congestion, goose bumps

optic nerve

vision; snellens chart

sighs/symptoms of subdural hematoma

**results from VENOUS bleeding

CN VIII

Vestibulocochlear

what medication is used to treat bells palsy?

acyclovir (antiviral)

what meds should you start a TIA patient on to decrease their risk of future stroke or TIA?

antiplatelets - aspirin or plavix

what should patients with bells palsy be taught to do at bedtime?

apply an eye patch to prevent against corneal irritation & ulceration

how should you approach a stroke patient who has sensory perception deficits?

approach them on the side that is still intact

risk factors for bacterial meningitis?

areas with high population density (army barracks, prisons, college dorms) tobacco use recent viral URI

how do you test cranial nerve VII?

ask the patient to smile and assess for symmetry

which cardiac dysrhythmia is associated with cardiogenic embolic strokes?

atrial fibrillation

what should you always have at the bedside if you are administering Tensilon?

atropine sulfate (antidote)

for a patient recovering from a stroke, what nursing intervention can help prevent contractures in the lower legs?

attaching braces or splints to each foot and leg

when providing discharge instructions to a patient with MS, which teaching point should the nurse emphasize?

avoid hot showers/baths

vestibulochoclear/acoustic nerve

balance and hearing have pt. stand with eyes closed, otoscopic exam

ADLs

bathing, toileting, and eating

trigeminal nerve

biting, chewing, and facial sensation ask pt. to open mouth and bite down; rub a cotton swab along their cheek and jaw to test for sensation

what is the most common early symptom of MS?

blurred vision from optic neuritis and tremors when performing activities

S, M or B: CN IX (Glossopharyngeal)

both

S, M or B: CN V (Trigeminal)

both

S, M or B: CN VII (Facial)

both

S, M or B: CN X (Vagus)

both

what are the prerequisites to diagnosing brain death?

coma of known cause as established by history, clinical examination, laboratory testing, and neuroimaging normal or near-normal core body temperature (higher than 96.8) normal systolic BP (higher or equal to 100 mmHg) at least one neurologic examination (some states and health care systems require two)

oculomotor nerve

controls most eye movement, pupil constriction & upper-eyelid rise have pt look up, down, and inward; ask pt. to follow your finger as you move it towards their face

what is a common cause of autonomic dysreflexia?

distended bladder - check for urinary retention

what do you assess when giving tPA?

double check the dose perform neuro assessments: VS Q 10-15 mins during infusion & Q30 after for 6 hours; monitor QH for 24 hours administer antihypertensives as prescribed if pt. becomes hypertensive assess for headache, bleeding, n/v obtain follow-up CT scan after treatment before starting anti-platelet meds

What are aspiration precautions?

elevate HOB at 30 degrees or more position patient in lateral or semiprone suction PRN

a rise in MAP indicates?

elevated ICP

treatment for epidural hematoma?

emergency craniotomy

Broca's aphasia

expressive aphasia (inability to produce speech)

facial nerve

facial expression; taste (sweet and salty) ask pt. to frown, smile, raise eyebrows, close their eyes, blow, etc. test tongue by giving them different foods

a nurse is assessing a patient's level of independent functioning. which tool would the nurse frequently use?

functional independence measure

what are the two types of myasthenia gravis?

generalized and ocular

what is the most common cause of acute encephalitis in the US?

herpes simplex virus (HSV)

what things should a patient with myasthenia gravis avoid?

hot tubs, sun bathing, saunas, bath tubs

what should you assess in patients with increased ICP receiving osmotic diuretics?

hydration status - osmolality + electrolytes urinary output - likely pt. has indwelling cath

which nerve controls the tongue and moving it side to side?

hypoglossal nerve

a decrease in MAP indicates?

hypoperfusion

neurogenic shock

hypoperfusion due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in the dilation of blood vessels that increases the volume of the circulatory system. That blood travels to interstitial tissues within the body and thus cannot perfuse vital organs

signs of neurogenic shock

hypotension, profuse vasodilation, and bradycardia

when should you avoid the use of triptans?

in migraine patients with a history of ischemic heart disease

when is a LB contraindicated?

in patients with increased ICP

how to adrenergic medications affect the circulatory system?

increased heart rate; adrenergic = sympathetic nervous system

you're caring for a patient with an upper motor neuron lesion. what findings would you anticipate?

loss of voluntary control and movement.

a patient has an acute brain injury with cerebral edema and is brought to ICU. What medication would be included?

mannitol (Osmitrol)

what things are considered IADLs?

meal preparation, grocery shopping, household management, finances and transportation

a basilar skull fracture can lead to what?

meningitis - from direct communication of CSF - with the ear & nasal passages, presenting with discharge (otorrhea & rhinorrhea) which is actually CSF

parts of neurological assessment

mental status, cranial nerves, mobility, motor function, sensation, reflexes and cerebellar function

signs/symptoms of epidural hematoma

momentary loss of consciousness --> "lucid intervals" that last for minutes --> RAPID deterioration back to unconsciousness ** *results from ARTERIAL bleeding enlarged pupil in one eye n/v confusion dizziness drowsiness

S, M or B: CN IV (Trochlear)

motor

S, M or B: CN VI (Abducens)

motor

S, M or B: CN XI (Accessory)

motor

expected findings for patient diagnosed with bacterial meningitis

neck flexion produces flexion of knees and hips

is there a test to diagnose guillane-bare syndrome?

no

coma

no purposeful responses to internal or external stimuli

is a change in LOC a normal part of aging?

no, that's NEVER normal

do MG patients take the same amount/dose of their meds every day?

no, their meds are self-adjusted via a safe dosing range given by their provider

a patients respiratory effort starts to increase, following a moderate head injury. What should the nurse do?

notify their care team and assess for s/sx of possible increases in ICP

what lobe of the brain is affected in a patient who presents with vision defecits?

occipital lobe

spinal shock

occurs immediately after a spinal cord injury and is a temporary loss of motor, sensory, reflex, and autonomic function below the site of injury & resolves usually within 48 hours

CN III

oculomotor

CN I

olfactory

triggers for headaches/migraines

organic disease - neurologic or other disease stress response vasodilation (migraine) skeletal muscle tension combination of factors certain foods, smells, and/or light

stroke rehab patient can now sit and stand. what is the client now able to use?

parallel bars

what area of the brain does visual receptive aphasia originate in?

parietal-occipital lobe

what things are considered ADLs?

personal hygiene/bathing, dressing/grooming, feeding and toileting

interventions for patients with autonomic dysreflexia

place patient in supine position or previous safe position, notify the provider (it's a neurologic emergency), assess for and treat the cause (check for urinary retention or catheter blockage), check for fecal impaction, examine skin for new signs or worsening

what are potential complications for patients with severe neurological disorders?

pressure injuries pneumonia VTE contractures

what does tensilon do?

prevents breakdown of acetylcholine

what position should you place a patient in post-lumbar puncture to prevent spinal headache?

prone position

first line therapy for myasthenia gravis

pyridostigmine

Creutzfeldt-Jakob disease

rare, transmissible, progressive disease of the CNS characterized by spongiform degeneration of the gray matter of the brain

early stage AD intervention

reality orientation

Wernicke's aphasia

receptive aphasia (inability to understand language/speech)

what is the normal physiologic neurological change associated with aging?

reduction in cerebral blood flow

pt. presents to ED with possible stroke. What would be absolute contraindication for thrombolytic therapy?

signs/symptoms of a hemorrhagic stroke, recent intracranial pathology current anticoagulation therapy symptoms for 3+ hours prior to admission

CN XI

spinal accessory

pt. in the ICU following severe spinal cord injury now has a major depression in reflex activity below the level of injury. What do you suspect?

spinal shock

what medications should you withhold before an EEG?

stimulants, coffee, tea, and coca-cola drinks

causes of bacterial meningitis?

streptococcus pneumoniae and Neisseria meningitidis

embolic stroke

stroke caused by a dislodged clot that travels to the cerebral arteries (the heart is the usual source of these emboli)

thrombotic stroke

stroke caused by a thrombus from the development of atherosclerosis (slow onset, evolving over minutes to hours - as it slowly forms a clot)

which brain bleed occurs over a longer period of time - subdural hematoma or epidural hematoma?

subdural because it's a venous bleed

what is the first key finding in autnomic dysreflexia?

suddenly HIGH blood pressure and bradycardia

vagus nerve

swallowing, speaking, and cough; facial sensation test pt. by coming from skin around the ear

a patient learning to ambulate with crutches advances both crutches and then lifts both feet, moving them forward and landing them in front of the crutches. The patient then repeats the motion. What type of crutch gait is this?

swing-through

is paralysis caused by guillain-bare temporary or permanent?

temporary

what test is performed to diagnose myasthenia gravis?

tensilon test

if a patient who is not able to respond to verbal commands, how should you assess their LOC?

through eye opening and closing

preventative non-pharmacological migraine interventions

toga meditation massage biofeedback exercise

glossopharyngeal nerve

tongue movement & swallowing; taste (sour & bitter) test pt. by giving them sour, bitter and salty substances

hypoglossal nerve

tongue movement (swallowing and speaking) inspect tongue & ask pt to stick tongue out

reason for cholinergic crisis?

too much acetylcholine - took too much of their medication

T/F: multiple sclerosis is a progressive degenerative disease.

true

what is one of the biggest risk factors for hemorrhagic strokes?

uncontrolled hypertension

which of the following nursing interventions should the nurse prioritize for a patient admitted with Guillain-Barre syndrome? using incentive spirometer as prescribed maintaining patient on bed ret providing aids to compensate for loss of vision assessing frequently for loss of cognitive function

using incentive spirometer as prescribed

late-severe AD intervention

validation therapy

preventative pharmacological interventions for migraine

vitamin B12 CoQ10 Magnesium Botox CGRP antagonists

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who had close contact with the patient?

within 24 hours of the exposure