ReMar Neurovascular Overview

What medication is given for myasthenia gravis?

-Anticholinersterase -Plasmapheresis

Nursing medications for head injuries

-Barbiturates -Mannitol -Corticosteroids

Diagnosis for spinal cord injuries

-CT scan -MRI

2 types of head injuries

-Closed head injury -Open head injury

Cerebellum

-Controls body movement -Maintains balance

Spinal cord injuries

-Damage to any part of the spinal cord -Result in permanent changes in strength sensations, and body functions below site of injury

Signs and symptoms of myasthenia gravis

-Difficulty talking/chewing -Weak eye muscles -Visual disturbances -Unsteady gait

Diagnosis for head injuries

-History and physical -CT scan -MRI

Treatment for bacterial meningitis

-IV antibiotics -IV fluids -IV diuretics to reduce fluids

Types of headaches

-Migraine -Cluster -Brain tumor

Nursing care for head injuries

-Monitor vital signs (fever is common) -Neurovascular check -Position (head of bed is 15-30 degrees, neck is NOT flexed/extended)

Cluster headaches

-More common in men -Location: behind forehead and eyes -Pts have watery eyes and nasal congestion -Lasts less than an hour -Treatment = Ergotamine tartrate and Methysergide maleate -If using methysergide maleate, discontinue for 1 month after using it for 4-6 months

Migraine headaches

-More common in women -Cause is unknown -Location: one sided or general -Pts have aura -Lasts 2 hours to several days -Clients appear pale and have nausea/vomiting -Treatment = Ergotamine tartrate -Sublingual/Inhaled routes -Take medication early in the migraine -During a migraine lie flat and drink black coffee

Signs of MS

-Muscle spasms -Weakness -Bowel/bladder dysfunction -Numbness in the extremities -Visual disturbances

Treatment for viral meningitis

-None -Pt should rest -Treat with plenty of fluids

12 Cranial nerves

-Olfactory -Optic -Oculomotor -Trochlear -Trigeminal -Abducens -Facial -Vestibulocochlear -Glossopharyngeal -Vagus -Accessory -Hypoglossal

Closed head injury

-Outside force impacts the head but skull is NOT broken -Damage is generalized

Brain tumor headaches

-Pain around the tumor -Weakness, visual loss, seizures, increased intracranial pressure -Remove tumor by surgery, chemo, or radiation -Diagnosis with MRI

Tensilon test

-Performed to diagnose myasthenia gravis -Test is positive if client's muscle strength is increased

Bacterial meningitis

-Requires antibacterial medications -Droplet isolation

2 types of cranial nerves

-Sensory -Motor

Open head injury

-Skull is broken, fractured, or penetrated -Specific parts of the brain are damaged

If you were at a MS conference, what would you teach?

-Start regular bladder/bowel program -Avoid stressful situations -Eat a well balanced diet -Initiate speech/physical therapy -Remove safety hazards in home

Signs for meningitis

-Stiff neck -Severe headache -Fever -Positive Brudzinski's sign -Positive Kernig's sign

Signs of head injuries

-Swelling of head -Nasal discharge -Bruising -Decreased LOC -Nausea/vomiting

What would you teach at a myasthenia gravis conference?

-Take meds 30 minutes before eating -Cough/deep breath -Exercise -Conserve energy by doing multiple short tasks -Try to decrease stress/infections/unhealthy habits

Viral meningitis

-Usually not treated -Requires no antibiotics -No isolation

2 types of meningitis

-Viral -Bacterial

Nursing interventions for spinal cord injuries

-Watch for ABCs (ventilator may be required) -Logroll patient -Bowel and bladder program -Reposition client every 2 hours

How many parts does the brain have?

3

A nurse is assessing the intracranial pressure of a client with head trauma. The nurse would compare the client's assessment data with which normative value for intracranial pressure? A. 0-15 mm Hg B. 20-35 mm Hg C. 50-60 mm Hg D. 90-110 mm Hg

A A normal ICP reading is 0 to 15 mm Hg represents a life-threatening condition requiring immediate intervention

Myasthenia Gravis

An autoimmune disease that results in extreme fatigue and muscle weakness

Positive kernig's sign

An inability to extend the leg while the hip is flexed to 90 degrees

A client with a brain tumor is admitted to the neurology unit. The nurse assesses the client, and the client has the following vital signs: 128/37, pulse 75, oxygen at 3 L/min via nasal cannula at 97%. The healthcare provider orders an indwelling urinary catheter. Before the procedure, the client has an assessment change. Which of the following should be reported immediately to the neurosurgeon? A. Temperature of 100 F and pulse of 93 B. Blood pressure of 135/52 and pulse of 50 C. Urine output of 35 mL during the past hour D. Temperature of 99.5 F and pulse of 96

B A blood pressure with a widening pulse pressure, bradycardia, and irregular respirations are associated with increasing intracranial pressure. This is known as Cushing's triad and should be reported immediately. The other assessment findings are normal and an expected finding in a postoperative client.

The nurse is caring for a client newly diagnosed with quadriplegia. Which of the following is the priority intervention? A. Turn the client every 2 hours B. Check the gag reflex C. Ask the client how he feels about his diagnosis D. Perform an arterial blood gas reading

B Clients who have paralysis of the upper and lower limbs are at risk of the airway also being affected depending on the location of the injury. The priority assessment of the gag reflex will allow the nurse to determine if the client can clear their airway. An absent gag reflex indicates a possible need for airway protection. Turning the client every 2 hours is essential to maintain skin integrity. Emotional support and asking the client how they feel is also important, but not a higher priority than airway management. The arterial blood gas reading will determine the client's pH level and overall acid-base balance, but this is not the priority over the gag reflex evaluation.

A nurse is caring for a 20-years-old client with multiple sclerosis who is prescribed medication to alleviate the major symptoms of this disease. Which drug classification would the nurse most expect to be used to treat multiple sclerosis? A. Anti-hypertensives B. Muscle relaxants C. Anticholinesterase D. Narcotic analgesics

B Multiple sclerosis causes the muscles to have spasticity as the loss of the myelin sheath progresses. Muscle relaxants decrease these spasms. Anti-hypertensives are not routinely used as hypertension is not related to multiple sclerosis. Anticholinesterase medications increase the level of the neurotransmitter acetylcholine at the nerve synapse to increase nerve impulse transmissions. Anticholinesterase are used in the treatment of myasthenia gravis, not multiple sclerosis.

Which neurological sleep disorder is characterized by an individual being unable to prevent falling asleep even when engaged in a task or activity? A. Parasomnia B. Nacrolepsy C. Orthopnea D. Insomnia

B Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime

A nurse is preparing for the admission of a 26 years old client who has a history of congestive hear failure and seizure disorder. Which of the following is the most appropriate to place in the client's room? A. Oral bit prevention device B. Oxygen delivery system C. Soft arm restraints D. Mobile sequential compression devices

B The client with a seizure disorder must remain safe. The protection of the airway during a potential seizure is the priority nursing intervention. This requires oral suction and oxygen delivery systems. The client should also be placed on the left lateral side. The nurse should not use an oral bit prevention device, trying to put an object in the client's mouth during a seizure could result in injury. The nurse should also not try to restrain the client as this could cause injury. The sequential compression device is a method of deep vein thrombosis that is not included in seizure precautions.

A client is admitted to the medical-surgical unit after sustaining a C7 spinal cord injury. What would be the most important nursing intervention during the acute stage of care? A. Monitoring vital signs B. Maintaining a patent airway C. Maintaining proper boy alignment D. Turning and repositioning every 2 hours

B The initial care for a client with a C7 spinal cord injury is focused on establishing and maintaining a patent airway and supporting ventilation. It is a priority to protect the airway as spinal edema may extend and cause paralysis of the diaphragm. Monitoring the client's vital signs maintaining proper body alignment, and turning and repositioning every 2 hours are not a higher priority than maintaining a patent airway.

A nurse is caring for a professional football player diagnosed with chronic traumatic encephalopathy. The healthcare provider orders daily MRI's, hourly neurologic checks, and incentive spirometry. At 5 am the client reports a headache. The nurse administers acetaminophen as a prescribed by the healthcare provider. At 6 am the client is resting quietly in bed. Which is the most appropriate action by the nurse? A. Quietly evaluate the client for changes in skin color, edema, or swelling B. Awake the client and ask him the date C. Allow the client to rest and document their position and pain relief D. Allow the client to rest but evaluate the respiratory status.

B The nurse is ordered to assess hourly neurological status. This includes asking the client their name, the date, the situation, and other information that would allow the nurse to determine if the client was alert and oriented. The nurse should not continue to let the client sleep as this client has suffered a head trauma and may become stable quickly. Checking the client for changes in respiratory status, skin color, edema, or swelling are not a part of the neurological exam.

What medication is given for spasms?

Baclofen

What is the malfunction in the body in myasthenia gravis?

Body produces antibodies that block acetylcholine receptors

Sensory cranial nerves

Brings information such as pain, touch, temperature, senses (vision and hearing)

The nurse is caring for a 6 month old client recently diagnosed with bacterial meningitis. Which of the following clinical signs would she expect to find? A. Presences of the Babinski sign B. Increased appetite and thirst C. Increased seizure activity D. Learning disabilites

C Bacterial meningitis is the most serious type of meningitis. It can lead to death or permanent disability. It is a medical emergency. Meningitis affects the meninges, the membranes that surround the brain and spinal cord, and protect the central nervous system, together with the cerebrospinal fluid. The most common clinical signs in infants are nuchal rigidity, increased seizure activity, hypothermia, decreased appetite, and vomiting. The presence of the babinski reflex is normal at the child's age. Learning disabilities would not be evaluated until the child is much older.

A client with a traumatic brain injury is diagnosed with occipital lobe damage. Which assessment finding would be most consistent with the diagnosis? A. Inability to feel pain B. Aphasia C. Decreased vision D. Personality changes

C Vision and visual processing occurs in the occipital lobe. The nurse would expect the client to have decreased vision

Diagnosis for meningitis

Check spinal cord fluid

Multiple Sclerosis

Chronic, progressive degenerative disease of the nervous system

Brainstem

Contains -Midbrain -Medulla oblongata -Pons

Is there a cure for MS?

No

Is there a cure for myasthenia gravis?

No

Responsibility of parietal lobe

Orientation and space

What medication will be given to reduce the amount of time a client experiences exacerbated symptoms?

Corticosteriods

A nurse is working in an emergency department. A client is brought with a limp left arm and a blood pressure of 180/95. The client has a delayed verbal response. Which is the priority action of the nurse? A. Administer metoprolol STAT B. Initiate a large bore intravenous line C. Prepare the client for an MRI to evaluate client condition D. Maintain a patent airway

D A client with a suspected stroke would have symptoms such as limp or flaccid extremities. The client is also presenting with delayed speech. In all emergency situations, the first nursing action is to secure and maintain a patent airway

A physician performs a lumbar puncture on a client. During recovery from the procedure, the client reports a severe headache. What is the most appropriate action for the nurse to take? A. Place the client on the left side B. Evaluate the client for swelling and urinary retention C. Place an ice pack over the lumbar insertion site D. Increase the client's fluid intake

D A headache after a lumbar puncture is usually caused by leakage or loss of cerebral spinal fluid. The nurse should increase fluid intake, either IV or oral, as tolerated. The nurse should also encourage the client to lie flat for 4 to 6 hours. Assessment is essential as headache may indicate a CSF leakage. The other item options are inappropriate to treat a severe headache after a lumbar puncture site

The nurse is caring for a 45-year-old female client who had a traumatic brain injury. The client has residual expressive aphasia. Which is the most appropriate expected outcome for this client? A. Express an understanding that the condition is permanent B. Changing the environment for ambulatory safety C. Verbalize the plans for rehabilitation D. Demonstrate alternative communication techniques

D Clients with expressive aphasia need to use an alternative form of communication to make their needs known and interact with others. Clients with expressive aphasia may not be able to communicate verbally; however, they may still communicate using other techniques. Changing the environment is not a related outcome for expressive aphasia. In some cases, expressive aphasia may not be permanent.

The nurse is caring for a client diagnosed with a stroke. The healthcare provider has prescribed to the client to take oral medications now. Before administering the oral medications, it would be most important for the nurse to assess which cranial nerves? A. Facial and vagus nerve B. Trigeminal and vagus C. Trigeminal and hypoglossal D. Glossopharyngeal and vagus

D Cranial nerves glossopharyngeal and vagus control the swallowing and the gag reflex. The nurse must assess the gag reflex before administering oral medications or feedings, to prevent the risk of aspiration. Cranial nerve VII controls the motor functions of the face and the taste sensation of the anterior 2/3rds of the tongue. Cranial nerve controls sensation of the forehead, face, nasal cavity, teeth, and eyes as well as the motor function of the muscles for chewing. Cranial nerve hypoglossal controls the motor function of the intrinsic and extrinsic muscles of the tongue.

A nurse is ordered to administer mannitol to a client with a traumatic brain injury. Which of the following is the primary expected outcome? A. Increased urine output B. Decreased blood pressure C. Increased intracranial pressure D. Reduced intracranial pressure

D Mannitol is an osmotic diuretic that causes an increased uptake of water and increased diuresis. This specifically helps to relieve cerebral edema and decreases intracranial pressure

The nurse is assisting a 2-years-old child with suspected bacterial meningitis. The child is ordered to have a lumbar puncture. Which of the following is the most appropriate nursing intervention? A. Monitor the client's vital signs every 5 minutes during the procedure B. Sterilize the client's skin at the insertion site with an appropriate alcohol-based solution C. Apply oxygen to the client to maintain optimal oxygen saturation D. Place the client on the lateral side with the head of knees tucked.

D The best position during a lumbar puncture for a child is to have the head and knees tucked in. The spine should be fully flexed and extended. Oxygen is an unnecessary intervention unless the client has a decreased or compromised airway. Skin cannot be sterilized. Skin can only be cleaned. Also, the healthcare provider doing the procedure is responsible for setting up the sterile field and cleaning the insertion site. The lumbar puncture procedure takes about 45 minutes; however, the client will not have to have the vital signs monitored every 5 minutes. The nurse can monitor the vital signs before and after the procedure. The client needs to be still during the spinal tap.

A client with head trauma has a urine output of 275 mL/hr. The nurse also notes dry skin, increased thirst, and dry mucous membranes. Which action is the priority for the nurse to take? A. Prepare the client for hemodialysis B. Turn off the intravenous fluids C. Continue to monitor the client over the next hour D. Evaluate the urine-specific gravity

D The client is experiencing manifestation of diabetes insipidus related to a decrease in the pituitary gland production of antidiuretic hormone as a result of a head injury. In this condition, the kidneys are unable to conserve water, and large amounts of fluid are excreted. The client has an appropriate kidney function and does not need hemodialysis. In clients with diabetes insipidus, the intravenous fluids should not be stopped as dehydration is likely to occur. The nurse should not only continue to monitor the client but check the urine specific to determine if it is trending low.

A nurse is caring for a client with frontal lobe damage. The client is suspected of having bacterial meningitis. Which action should the nurse take first? A. Establishing intravenous access via a peripheral catheter B. Preparing the client for a lumbar puncture C. Checking the client for Brudzinski's sign D. Placing the client under droplet isolation

D The client with suspected bacterial meningitis should not be placed on droplet precautions isolation until the identified and appropriate treatment is initiated. Meningococcal meningitis is highly contagious and is easily transmitted to others. The client must remain on droplet precautions for the safety of the other clients. The other interventions are important but not the priority over isolation.

The nurse is caring for a client after a lumbar puncture. Which assessment finding should be reported to the healthcare provider immediately? A. Client reports a headache B. The client is in a prone position C. The client is reporting thirst D. The client's insertion site bandage is saturated with clear fluid

D The nurse should contact the healthcare provider if there is a continuous leaking of cerebrospinal fluid. This indicates that the subdural space is still open and allowing fluid is able to escape. Fluids are encouraged to help replace the cerebrospinal fluid they lose during the lumbar puncture. If a client is thirsty, they can drink. The client should remain in the prone or supine position after the procedure. Headaches are a common finding after the lumbar puncture. The prescribed analgesic should be administered.

The nurse is working on the neurology unit. She is assigned a client with a history of migraine headaches. Upon assessment, the nurse notes the following changes, which is the most important to communicate to the HCP? A. The client only ate 10% of their lunch tray B. The client reports sensitivity to light and sounds C. The client has a respiratory rate of 12 D. The client appears drowsy and apathetic

D The nurse should report changes in the client's level of consciousness. This indicates a reliable measure of decreased oxygenation saturation or increased cranial pressure. Clients with migraine headaches typically have an increased sensitivity to lights and sounds. A respiratory rate of 12 to 20 breaths per minute is considered a normal finding.

What part of the nervous system is affected by MS?

Demyelinization of the white matter of the brain and spinal cord

Cerebrum

Divided into 2 halves called heispheres

Responsibility of frontal lobe

Emotions

Responsibility of temporal lobe

Hearing and taste

Positive brudzinski's sign

Includes involuntary flexion of the hip and knee when the neck is bent forward

Responsibility of occipital lobe

Maintain and have vision

Headaches

Most are not caused by structural disorders but by problems coping with life situations

Brain

Part of the central nervous system that lies inside the skull

Motor cranial nerves

Sends instructions to head, neck and face for expressions and eye movement

Meningitis

Starts in the upper respiratory system then it goes to the spinal cord

Do the symptoms of myasthenia gravis worsen with activity?

Yes