Chapter 68 Management of pt's with neurological infections, auto immune disorders and neuropathies.

The nurse and a nursing student are admitting a client with a malignant glioma brain tumor preoperatively for resection of the tumor. The nursing student asks the nurse, " I was told these types of tumors have a very poor prognosis. Why is the tumor being resected?" Which rationale for this intervention is true?

"Surgical resection of the tumor will decrease intracranial pressure."

Cluster Ha

**Pain that radiates to forehead, temple and cheek** -several wks to months then disappear for a long time -usually similar time of yr -more male than female - exact cause is unknown The pt should avoid etoh, nitrates, vasodilators, and histamine

A patient has been diagnosed with a deficiency of the major neurotransmitter acetylcholine. Based on this information, the nurse knows to assess the patient for complications associated with:

- heart rate and Rhythm

Tx for Cluster HA

-Administration of *100% oxygen, corticosteroids, injectable forms of ergotamines or sumatriptan*, and analgesics (e.g., intranasal butorphanol).

Which nursing goal is a priority when caring for a client newly diagnosed with vertigo?

-Client will remain safe while ambulating in the home.

Things to know about seizure meds

-Pt's will have to have there levels checked regularly. -Hepatotoxicity, anemia and skin rashes can occur. - Avoid food that interfere with absorption (grapefruit and citrus juice) -Coumadin and Dilantin potentiate each other can increase risk of bleeding or dilantin toxicity. Must not stop meds even in the absence of sz's.

legally blind

20/200

Huntington's disease

A human genetic disease caused by a dominant allele; characterized by uncontrollable body movements and degeneration of the nervous system; usually fatal 10 to 20 years after the onset of symptoms. NO TREATMENT just symptom control

Migraine treatment: Abortive therapy

Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis (e.g., propranolol, topiramate, CCBs, amitriptyline) Pt that are 55 and older can have ibuprofen due to the possibility of vasoconstriction with these ex's. Priority is pain control

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?

Amyotrophic lateral sclerosis

Drug therapy in MS: Monoclonal Tysabri

Binds to WBCs to prevent further damage to myelin

Head aches

Can be Primary or secondary

Phases of Migraines: Recovery

Can last up to 25 hrs Termination phase- intensity of ha decreases Post prodrome- pt is fatigues, irritable, and has muscle pain.

Which of the following brain structures is responsible for equilibrium?

Cerebellum

A patient recently noted difficulty maintaining his balance and controlling fine movements. The nurse explains that the provider will order diagnostic studies for the part of his brain known as the:

Cerebellum.

Which of the following diagnostic studies provides visualization of cerebral blood vessels?

Cerebral angiography

Drug therapy in MS: Novantrone

Chemo drug; used for excerbrations has been shown to reduce neurologic disability.

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate?

Conductive

MS (multiple sclerosis)

Disease of the CNS - immune system attacks the protective myelin sheath that covers nerve fibers. sclerosis=hardening

Dopamine- Acetylcholine balance

Dopamine is an inhibitory neurotransmitter that is responsible for fine motor VOLUNTARY tasks. Acetylcholine is an excitatory neurotransmitter. Dopamine and acetylcholine work together to refine fine motor tasks by keeping each other in balance. once dopamine is inhibited....acetylcholine is able to take over.. thus causing tremors, and rigidity.

Secondary HA

Due to other pathology; tumors, bleeds, head trauma, cysts. Has an attributable causation.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?

Dysphonia

CSF test for MS

Elevated protein and WBC, increase in myelin basic protein and increased levels of IgG. 2 separate attacks.

Tetrabenazine (Xenazine)

First drug of any kind approved specifically for HD. Treats chorea, works to decrease amount of dopamine available at synapses in the brain and thus decreases the involuntary movements of chorea. High risk of suicide with this rx.

Drugs for Parkinsons: MAOI

For early or mild PD. Work by slowing the main type (b) of monoamine oxidase in the brain, increasing dopamine concentration. Lots of bad things to remember: Aviod foods with Tyramine, Bananas,raisins avocados chocolate, meats. Interacts with ALOT of Rx

Which lobe of the brain is responsible for concentration and abstract thought?

Frontal Lobe

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc?

Have the client lie on the back and lift the leg, keeping it straight.

A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that:

Hearing loss usually occurs.

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color?

Hemangioma

Which of the following areas of the brain are responsible for temperature regulation?

Hypothalamus

Gillian Barre syndrome

Immune response an inflammation of the myelin sheath of peripheral nerves - rapidly worsening muscle weakness that can lead to temporary paralysis may have permanent damage if damage to axon occurs. Uncommon disorder effects men and women =

The client is having a Weber test. During a Weber test, where should the tuning fork be placed?

In the midline of the client's skull or in the center of the forehead

Tonic sz

Increase in muscle tone, LOC lasting 30 seconds to several min.

Things that trigger a seizure

Increased physical activity, emotional stress, excessive fatigue, etch, caffeine, certain foods and chemicals.

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?

Instill a few drops of warmed mineral oil to cover the insect.

Complex partial seizure

LOC and black out for 1-3 min with automatisms. Wanders at the beginning of the sz; amnesia afterwards. mostly occurs in the temporal lobe so they are often called psychomotor.

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?

Laser-assisted stromal in situ keratomileusis (LASIK)

A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following?

Listening skills

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Logroll the client from side to side.

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:

Loss of accommodative power in the lens.

neurological disorders caused by Virus or auto-immune:

MS Gullian Barre Myasthenia Gravis

Types of migraines (3)

Migraine with an aura :(sensation or signal that alerts to the onset of impeding Migraine ha) Aura involves one or more of the 5 senses. Migraine w/o Aura: (most common) may last 10-30 min prior to ha consists of Visual field deficit, dizziness, confusion, tingling or burning. Accounts for 85% of ha. Atypical Migraine: (least common) include menstrual or cluster ha.

Drugs for Parkinsons: Dopaminergics

Mimic Dopamine, work in the first 3-5 years. adverse stuff: orthostatic hypotension, hallucinations fatigue.

Drug therapy in MS: Interferon Beta/ Avonex

Modifies the course of the disease ad acts like an antiviral SE: flu like symptoms, depression, possible liver damage CBC and LFTs q/ 6 months

Absent seizure (petit mal sz)

More common in children. brief LOC, blank starring, the pt is unaware of the activity. Eyes can flutter, automatisms lip smacking and picking at clothing. This is involuntary behavior.

Drugs for Parkinsons: Anticholinergic

Old rx for severe tremors causes bad side effects. example cogentin

If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for

Ophthalmoscopy.

Which condition is characterized by the formation of abnormal spongy bone around the stapes?

Otosclerosis

Which term refers to swelling of the optic disc due to increased intracranial pressure?

Papilledema

Degenerative Neurologic Disorders:

Parkinson's huntingtons ALS

The nurse educator is teaching nursing students about various types of brain tumors. The instructor recognizes that teaching has been effective when students correctly identify a client whose lab work indicates excessively high levels of thyroid stimulating hormone would most likely be diagnosed with which type of tumor?

Pituitary adenoma

Which condition refers to hearing loss associated with degenerative changes?

Presbycusis

Phases of Migraines: Prodrome

Pt has a specific symptoms such as mood changes, or food cravings. The pt will usually have the same prodrome each migraine.

The nurse is caring for an 8-year-old and anticipates that the client has otitis externa from symptoms stated on the history. Which symptoms, from the history and physical examination, would confirm the diagnosis?

Pus noted in the ear canal

Generalized seizures

Seizures that involve the entire brain Tonic- clonic absent myoclonic atonic tonic clonic

Clonic Sz

Several min's of muscle contraction and relaxation

Drugs for Parkinsons: Combo

Sinemet/ Levodopa/carbidopa: Time released rx Levodopa: Crosses the blood-brain barrier and is coverted to dopamine. Carbidopa: Doesn't cross the BBB, this rx prevents the breakdown of levodopa before it crosses. Things to remember: take with food, no B6 SE:dizziness, occasional involuntary movements tardive dyskinsthia.

Atonic sz

Sudden loss of muscle tone, followed by a post ictal confusion. Usually the cause for a fall.

Which client should the nurse assess for degenerative neurologic symptoms?

The client with Huntington disease

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

Turning the client from side to side, using the logroll technique

Primary HA

Type: migraine, tension, cluster. No organic cause can be identified.

Simple Partial seizure

Unconsciousness during entire sz episode, aura prior, movement of one extremity, unusual sensation and changes in hr, skin flushing and epigastric pn.

Tensilon test

Used to diagnose MG and to differentiate between myasthenic crisis and cholinergic crisis.

Phases of Migraines: Aura

Usually lasts less than 1 hr, visual changes, flashing lights, diplopia, spots, numbness and tingling in lips, face or hands. Drowsiness. Involves 5 senses

Migrane causes

Vascular Genetic neurological hormonal and environmental no cause Low Mg levels in brain.

Precipitating factors to MS

Virus, Physical injury, emotional stress, excessive fatigue,and pregnancy.

myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles

Drug therapy in MS: Anticholinergics

bladder sysfunction

Parkinson's disease

degeneration of the dopamine-releasing neurons of the substantial nigra (which produce dopamine). Evidenced by tremors, slow movement, mask face, uncontrolled drooling, diff chewing and swallowing, trouble with fine voluntary movement.

Drug therapy in MS: Copaxone

drug classified as an immunomodulator. It is thought to work by preventing your immune system from attacking the nerves in your brain and spinal cord.

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:

electromyography (EMG).

ALS (amyotrophic lateral sclerosis)

fatal degenerative disease of the motor neurons marked by muscle weakness and atrophy Effects men 2:1 onset 40-70 starts in one area and spreads to the whole body.

Types of Seizures:

generalized and partial

Farsightedness

hyperopia

Tonic/ Clonic Seizure (grand mal sz)

lasts 2-5 minutes beginning with a tonic phase that causes stiffening or rigidity of the muscles, and immediate loss of consciousness, clonic or rhythmic jerking of all extremities follows, may bite tongue (never stick anything in there mouth), may be incontinent, confusion or lethargy may last afterwards up to 1 hr.

Phases of Migraines: Headache phase

may last few hours or few days 4-72 hrs. Pt has symptoms of photophobia, photophobia and nausea.

nearsightedness

myopia

Why does caffeine work in migraine ha therapy?

narrows blood vessels by blocking adenosine which dilate vessels and increase inflammation. It also potentiates app.

Drugs for Parkinsons: COMT catechol O methyltransferases

prolong the action of levadopa

Myoclonic sz

quick repetitive contraction of muscle (arm twitch or face)

Drugs for Parkinsons: Antihistamines

relieves tremors and rigidity. causes sedation though

Choreiform

repetitive/rapid/jerky/involuntary movements that appears well coordinated dance like movements

Partial Seizures

simple and complex. Focal and only occur in 1 hemisphere of the brain. Some times they will advance into generalized. These sz are more resistant to rx and hard to dx especially in the elderly.

Causes of status epilepticus

sudden withdrawal from meds brain lesion/trauma cerebral edema metabolic disorders alcohol or drug withdrawal infections

Drugs for Parkinsons: Antivirals

symmetry reduces rigidity, tremors, bradykinesia and postural changes early in the disease.

Drug therapy in MS: muscle relaxants

used to lessen muscle spasticity

Axons effected by MS

usually Optic, Pyramidal tracts, posterior columns and brainstem Nuclei.

Onset of new sz in older pt's

usually due to ti HTN, Cardia disease, DM, CVA and Alzheimer's.

A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?

• Instillation of mineral oil

The nurse is caring for a client after lumbar puncture. The client reports a severe headache. Which actions should the nurse complete?

• Maintain the client on bed rest. • Administer fluids to the client. • Administer analgesic medication

The nurse is caring for a client with recurrent ear infections. The nurse assesses the client for further infectious processes traveling deeper into the tissue and becoming more lethal. Which infection, originated in the ear, is of most concern?

• Meningitis

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder?

• Prolonged use of corticosteroids

An older adult patient informs the nurse, "I don't see as well as I used to." What should the nurse explain to the patient about why vision becomes less efficient with age?

• There is a decrease in pupil size. • There is slowing of accommodation. • There is an increase in lens opaqueness.