med/surg Ch 14 Neurologic disorder CASPN

This question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem.

"Can you describe the sensations you are having?"

Occipital Lobe

An area at the back of each cerebral hemisphere that is the primary receiving area for visual information.

Cerebrum

Frontal lobe, parietal lobe, temporal lobe, occipital lobe

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment?

Fund of knowledge

What are points to teach client while taking levodopa/carbidopa (Antiparkinson)?

GI irritation may decrease by eating food shortly after taking meals High protein meals may impair drugs effects May cause drowsiness or dizziness Oral hygiene for dry mouth Avoid multivitamins-vitamin B6 and iron may decrease effectiveness

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

Gently wipe nose with absorbent gauze

Types of seizures.

Grand mal; petit mal; psychomotor; jackson focal; myoclonic, akinetic

Assessment of the Neurological System

History, metal status, level of consciousness, language and speech, cranial nerve function, motor function, sensory and perceptual status

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?

Hypotension

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

Myelogram

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

Neurotransmitters

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

Promotes nerve impulse transmission

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

To walk with hands clasped behind back to help balance

Stroke

abnormal condition of the blood vessels of the brain

Meningitis

acute infection of the meninges

Encephalitis

acute inflammation of the brain caused by a virus

Pharmacological management for headaches

aspirin, acetaminophen, ibuprofen, ergotamine tartrate, codeine; inderal

Increased intracranial pressure medication management

corticosteriods, antacids; histamine-receptor blockers, anticonvulsants

Parkinson's disease

damage or loss of dopamine

In what ways can the nurse word questions to get to the most accurate answer?

open-ended-questions

AutoResult of abnormal cardiovascular response to stimulation of the sympathetic division of autonomic nervous sytem as a result of this triggered by bladder distention and fecal impaction.

Autonomic dysreflexia Theory: Involves vagus nerve and hormones

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

Checking the affected side of mouth for food accumulation, Offering small bites of food, Adding a thickening agent to liquids

What are surgical navigational systems?

Computerized devices that guide the surgeon

Structural divisions of the brain.

Central Nervous System -Brain and spinal cord. Peripheral Nervous System -Somatic Autonomic nervous system

What are the two divisions of the nervous system?

Central and the peripheral

Mannitol controls what?

Cerebral edema.

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

Concentration, Wakefulness, Attention, Introspection

Pons

Connects the midbrain to the medulla oblongata; the word pons means "bridge" It is the origin of cranial nerves 5-8. The pons is composed of myelinated nerve fibers and is responsible for sending impulses to the structures that are inferior and superior to it.

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

Decrease in the level of consciousness

ICP nursing interventions

Elevate HOB 35-45 deg Neck in neutral pos. Avoid flexion of hips Avoid isometric or resistive exercises Restrict fluid intake Avoid valsalva maneuvers Foley O2 Control body temp

Manifestations for autonomic dysreflexia. First manifestation

Goosebumps/Gooseflesh

What is the first sign of Bell's palsy?

Inability to wrinkle forehead and pucker lips on affected side

stroke risk factors

Non-modifiable Risk Factors: Age (over 65!), Gender, Ethnicity/race (african american), Family history/heredity Modifiable Risk Factors: Hypertension, Heart disease, Diabetes mellitus, Smoking, Obesity, Sleep apnea, Metabolic syndrome, Lack of physical exercise, Poor diet, Drug and alcohol abuse.

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

Nystagmus

Statis epilepticus

Patient is not able to regain full consciousness. Is a medical emergency that requires medical intervention to prevent brain hypoxia.

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

Place the child in respiratory isolation

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

Postictal period

What is the purpose of a "drug holiday"?

Restart drugs at a lower dosage with favorable results

What are the three signs of Cushing response?

Widened pulse pressure, Bradycardia, Increased systolic blood pressure

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

Yogurt, Caffeine, Marinated foods, chocolate, vinegar.. foods that contain tyramine, nitrites, or glutamates, MSG (chinese food, and processed meats)

hemianopia

defective vision/blindness in one half of the the visual field

dysphagia

difficulty swallowing

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

feed self with setup and adaptive equipment

apraxia

inability to carry out learned sequential movements on command, perform purposeful acts, or use objects properly

Guillain-Barre syndrome

inflammation and demyelination of the peripheral nervous system

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

myelin

Myasthenia gravis

neuromuscular disorder; nerve impulses fail to pass at the myoneural junction, causes muscular weakness

postictal period

post-seizure period

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

sensation in lower extremities.

proprioception

sensation; body's way of sensing where a limb is

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

shuffle with arms flexed.

medulla oblongata

the continuation of the spinal cord within the skull, forming the lowest part of the brainstem and containing control centers for the heart and lungs.

agnosia

total or partial loss of the ability to recognize familiar objects by sight, touch, or feeling or to recognize familiar people through sensory stimuli; result of organic brain damage

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

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

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 the patient?

Neck placed in a neutral position

Brainstem

The central trunk of the mammalian brain, consisting of the medulla oblongata, pons, and midbrain, and continuing downward to form the spinal cord

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

The disease can rapidly progress into respiratory failure

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

Vagus nerve

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:

from the left side.

Stroke clinical manifestation and assessment

headache, sensory deficit, hemiparesis;hemiplegia, dysphagia or aphasia

Bell's palsy

inflammatory process involving the facial nerve

The nurse explains that the triad of signs of Parkinson disease is: _______, _______ and _______

tremors, rigidity, and bradykinesia

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

12

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

3 hours

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?

It is possibly a temporary condition and will clear.

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?

Proprioception

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

Second stage

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

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

Spinal Cord

The cylindrical bundle of nerve fibers and associated tissue that is enclosed in the spine and connects nearly all parts of the body to the brain, with which it forms the central nervous system.

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?

Obtain an allergy history before the test.

Injury from T6-T7 will cause what?

Paraplegia and autonomic dysreflexia

aphasia

language function is defective or absent due to injury in certain areas of the cerebral cortex; expressive or interpretive

Phenytoin patient teaching

-Goal of treatment: minimize and eliminate seizure events. Before initiating treatment, identify type of seizure involved. -Clinical evaluation: is needed to determine a safe and effective dosage. -Identify high-risk patients: Patients with sinus bradycardia, sinoatrial block, and second or third AV block, or Strokes-Adams syndrome are contraindicated. -Promoting adherence: seizure control requires rigid adherence, non-adherence is a major cause of therapeutic failure. Warn about dangers of abrupt withdrawal (SE events) -Advise patients to avoid potentially hazardous activities until seizure control is achieved. Minimizing adverse side effects: Inform patients of common sideffects and their mitigation (gingival hyperplasia & oral hygiene), dermatologic reactions, warn patients about use of other CNS depressants (alcohol/benzodiazapines). Advise women about teratogenic effects.

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events.

1)Extremely stressful or frightening event 2)Sympathetic nervous system dominates 3)Heart rate and blood pressure rise, secretion of adrenaline 4) Parasympathetic nervous system dominates 5) Blood pressure, heart rate, and adrenaline output decrease

Hypothalamus

A neural structure the directs several maintenance activities - homeostasis (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.

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

Agnosia

Temporal Lobe

An area on each hemisphere of the cerebral cortex near the temples that is the primary receiving area for auditory information and memory. Auditory and visual pattern recognition.

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?

As individual scores in each category

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

Can understand the spoken word, but cannot speak

Thalamus

Brain structure that receives messages from the sense organs and relays the information to the appropriate region of the cerebrum for further processing

Parietal Lobe

Located in the upper back half of the brain. Receives and processes sensory information from the body and skin senses as well as other sensory areas in the brain. Association areas are involved with spatial reasoning and sensing the position of the body in space.

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

Memory loss that disrupts daily life

Frontal lobe governs what?

Morals, emotions, reasoning and judgements, concentration and abstraction.

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

Sit upright and check blood pressure

Cerebellum

The part of the brain at the back of the skull in vertebrates. Its function is to coordinate and regulate muscular activity.

Phenytoin: Antiepileptic/Anticonvulsant/hydantoin derivative

Therapeutic Use: -Can treat all major forms of epilepsy, except absence seizures -Most effective against tonic-clonic seizures -Can be administered by IV to treat generalized convulsive SE -Also used against dysrhythmias. Side Effects: Nausea, Vomitting, Rash, Nystagmus: (rapid eye movement), Ataxia: (loss of full control of body movements), Slurred Speech, Dizziness, Gingival Hyperplasia, Confusion, Blurred vision

Which symptom is specific to migraine headaches?

They are preceded by an aura

Tonic phase lasts typically how long? Clonic phase lasts about how long?

Tonic: 10-20 seconds. Clonic: 30-40 seconds.

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?

Tuck chin when swallowing

Protection precautions for seizure activity.

Padding bed rails. Rails up