medsurg 58, 60
Multiple Sclerosis Patient Profile D.S., a 32-yr-old white woman of European descent, born and raised in Minneapolis, is diagnosed with MS after an episode of numbness and tingling on the left side of her body that started several months ago. Two years ago she had an episode of viral neuritis in the right eye. Subjective Data • Difficulty seeing out of the right eye; denies dry eyes or mouth, ruling out Sjögren's disease • Numbness and tingling on the left side that worsens in hot weather • Tires easily • Used all sick days at work; concerned about losing her job and her ability to care for her 3-yr-old son Objective Data • Cries softly during the interview • Appears tense and anxious • Results of visual evoked potential: prolonged in right eye • MRI of the brain shows several plaques in white matter; ruling out fibromyalgia and stroke • No rash and negative test for Lyme disease • No cobalamin deficiency Discussion Questions Using a separate sheet of paper, answer the following questions: 1. What is the pathophysiology of MS? 2. What risk factors does this patient have? 3. What precipitating factors for MS are present in D.S.'s life? 4. Patient-Centered Care: D.S. asks, "Why did it take so long for a definitive diagnosis to be made?" What is the best answer you can give her? 5. Priority Decision: What are the priority teaching needs for D.S.? 6. What treatment would be appropriate for D.S.? 7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
1. The cause of MS is unknown, although research findings suggest that MS is related to genetic susceptibility with precipitating factors including infectious, immunologic, and environmental factors. T cells are activated by some unknown factor and these T cells migrate to the CNS and cause a disruption in the blood-brain barrier. Subsequent antigen-antibody reaction within the CNS activates the inflammatory response and through multiple mechanisms, demyelination of axons occurs. There is loss of myelin, disappearance of oligodendrocytes, and eventual damage to the underlying axon. The nerve impulse transmission is disrupted, resulting in permanent loss of nerve function. As inflammation subsides, glial scar tissue replaces the damaged tissue, resulting in characteristic hard sclerotic plaque formation scattered through the CNS. 2. The risk factors this patient has are being female between 20 and 50 years of age and being a European American from the northern United States. 3. The role of precipitating factors, such as exposure to pathogenic agents, in the etiology of MS is controversial. It is possible that their association with MS is random and that there is no cause- and-effect relationship. Possible precipitating factors for this patient include emotional stress, fatigue, pregnancy, and a poorer state of health. It is also possible that the viral neuritis was a precipitating factor. 4. Because there is no definitive diagnostic test for MS, diagnosis is based primarily on history and clinical manifestations. Although MRI can detect sclerotic plaques, her initial symptoms were so nonspecific and transient that a "wait-and-see" approach is often taken. The evidence of at least two plaques in the white matter seen with MRI, several attacks occurring, and other diagnoses being ruled out support the current diagnosis of MS. 5. Patient teaching should focus on avoiding triggers of exacerbations (e.g., upper respiratory tract infection, trauma, immunization, childbirth, stress) or worsening of the disease. Building general resistance to illness, including avoiding fatigue, stress, extremes of heat and cold, and exposure to infection, is an important measure in maintaining general health. Vigorous and early treatment of infection is critical if it does occur. It is important to teach the patient to achieve a good balance of exercise and rest, minimize caffeine intake, and eat nutritious, well-balanced meals with roughage to avoid constipation. Patients should know their treatment regimens, side effects of medications, and drug interactions with over-the-counter medications. The patient should consult the HCP before taking nonprescription medications. 6. Because there is no cure for MS, medical treatment is aimed at slowing the disease process, providing individualized symptomatic relief, and maximizing neuromuscular function. Nursing care will focus on these as well as maintaining independence, managing fatigue, optimizing psychosocial well being, adjusting to the illness, and reducing exacerbations. The disease process is treated with drugs and symptoms are controlled with a variety of medications and other forms of therapy. 657 • Immunomodulator drugs: Interferon β-1b (Betaseron), interferon β-1a (Avonex or Rebif), and glatiramer acetate (Copaxone) are used to modify the disease progression and prevent relapses, but the drugs are administered parenterally. Teriflunomide (Aubagio) is an immunomodulatory agent with antiinflammatory properties. The exact mechanism of action is unknown but may involve a reduction in the number of activated lymphocytes in the CNS. Liver function must be monitored. • Immunosuppressant for aggressive MS: The antineoplastic drug mitoxantrone reduces both B and T lymphocytes and macrophages. It is dose limited because of cardiotoxicity. • Sphingosine1-phosphate receptor modulator: Oral fingolimod (Gilenya) reduces the rate of relapses in relapsing-remitting MS by preventing lymphocytes from reaching the CNS and causing damage. • Monoclonal antibody: Natalizumab (Tysabri) is used when patients have an inadequate response to other drugs but has increased risk of progressive multifocal leukoencephalopathy. • Corticosteroids: These are most helpful in treating acute exacerbations of MS by reducing edema and acute inflammation at the site of demyelination, but the ultimate outcome is not affected. • However, the potential benefits of these drugs in patients with MS must be weighed against the potentially serious side effects. Physical therapy, speech therapy, and occupational therapy may also help to improve or neurologic function. 7. Nursing diagnoses: • Impaired comfort related to numbness and tingling on her left side for several months • Interrupted family processes related to shift in health status, potential financial problems, and fluctuating physical condition • Ineffective health management related to knowledge deficit regarding management of MS • Anxiety related to diagnosis of a chronic disabling illness • Disturbed sensory perception: visual related to prolonged visual evoked potential in right eye • Risk for impaired parenting related to fatigue and numbness and tingling on left side Collaborative problems: Potential complication: blindness, impaired physical mobility, urinary incontinence
What action should the nurse include in completing a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS)? Assess for the presence of chest pain. Inquire about urinary tract problems. Inspect the skin for rashes or discoloration. Ask the patient about any increase in libido.
2- Infection is a cause of a flare of MS
Which patient problem should the nurse identify as of highest priority for a patient who has Parkinson's disease and is unable to move the facial muscles? Activity intolerance Inadequate nutrition Disturbed body image Impaired physical mobility
2- nutrition is a problem if patient can not control facial muscles needed for eating
A patient with Parkinson's disease has bradykinesia. Which action should the nurse include in the plan of care? Instruct the patient in activities that can be done while lying or sitting. Suggest that the patient walk like "stepping over an invisible line" Have the patient take small steps in a straight line directly in front of the feet. Teach the patient to keep the feet in contact with the floor and slide them forward.
2. Patient should be taught to walk by lifting toes off ground and step over an invisible line. No shuffling allowed!!!
What should the nurse advise a patient with myasthenia gravis (MG) to do? Anticipate the need for weekly plasmapheresis treatments. Complete physically demanding activities early in the day. Protect the extremities from injury due to poor sensory perception. Perform frequent weight-bearing exercise to prevent muscle atrophy.
2. Patients with MG are stronger in the morning
Which assessment data for a patient who has Guillain-Barré syndrome will require the nurse's most immediate action? The patient's sacral area skin is reddened. The patient reports severe pain in the feet. The patient is continuously drooling saliva. The patient's blood pressure (BP) is 150/82 mm Hg.
3- airway may be compromised if patient cannot control secretions (swallowing problem)
A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "MS is associated with an increased risk for congenital defects." d. "Symptoms of MS are likely to become worse during pregnancy."
A During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.
A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)? a. Provide an elevated toilet seat. b. Cut patient's food into small pieces. c. Serve high-protein foods at each meal. d. Place an armchair at the patient's bedside. e. Observe for sudden exacerbation of symptoms.
A, B, D Because the patient with Parkinson's disease has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinson's disease is a steadily progressive disease without acute exacerbations.
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for methylprednisolone (Solu-Medrol) 150 mg IV. The label on the vial reads: methylprednisolone 125 mg in 2 mL. How many mL will the nurse administer?
ANS: 2.4 With a concentration of 125 mg/2 mL, the nurse will need to administer 2.4 mL to obtain 150 mg of methylprednisolone.
A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? Observe for agitation and paranoia. Assist with active range of motion (ROM). Give muscle relaxants as needed to reduce spasms. Use simple words and phrases to explain procedures.
Assist with active range of motion (ROM). ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate the patient's bowel sounds. b. Notify the patient's health care provider. c. Administer the prescribed PRN antiemetic drug. d. Give the scheduled dose of prednisone (Deltasone).
B The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness
C Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives
C Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.
Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient walks a mile each day for exercise. b. The patient complains of pain with neck flexion. c. The patient has an increased serum creatinine level. d. The patient has the relapsing-remitting form of MS.
C Dalfampridine should not be given to patients with impaired renal function. The other information will not impact whether the dalfampridine should be administered.
A patient is hospitalized with new onset of Guillain-Barré syndrome. The most essential assessment for the nurse to complete is a. determining level of consciousness. b. checking strength of the extremities. c. observing respiratory rate and effort. d. monitoring the cardiac rate and rhythm.
C The most serious complication of Guillain-Barré syndrome is respiratory failure, and the nurse should monitor respiratory function continuously. The other assessments will also be included in nursing care, but they are not as important as respiratory assessment.
Which of these nursing actions for a patient with Guillain-Barré syndrome is appropriate for the nurse to delegate to experienced unlicensed assistive personnel (UAP)? a. Nasogastric tube feeding q4hr b. Artificial tear administration q2hr c. Assessment for bladder distention q2hr d. Passive range of motion to extremities q4hr
D Assisting a patient with movement is included in UAP education and scope of practice. Administration of tube feedings, administration of ordered medications, and assessment are skills requiring more education and expanded scope of practice, and the RN should perform these skills.
Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? a. Activity intolerance b. Self-care deficit: toileting c. Ineffective self-health management d. Imbalanced nutrition: less than body requirements
D The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson's disease, but the data do not indicate that they are current problems for this patient.
After change-of-shift report, which patient should the nurse assess first? Patient with myasthenia gravis who is reporting increased muscle weakness Patient with a bilateral headache described as "like a band around my head" Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) Patient with Parkinson's disease who has developed cogwheel rigidity of the arms
Patient with myasthenia gravis who is reporting increased muscle weakness Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications.
A patient with Parkinson's disease has bradykinesia. Which action will the nurse include in the plan of care? Instruct the patient in activities that can be done while lying or sitting. Suggest that the patient rock from side to side to initiate leg movement. Have the patient take small steps in a straight line directly in front of the feet. Teach the patient to keep the feet in contact with the floor and slide them forward.
Suggest that the patient rock from side to side to initiate leg movement. Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.
Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? Encourage a decreased evening intake of fluid. Teach the patient how to use the Credé method. Suggest the use of adult incontinence briefs for nighttime only. Assist the patient to the commode every 2 hours during the day.
Teach the patient how to use the Credé method. The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.
Which assessment data for a patient who has Guillain-Barré syndrome will require the nurse's most immediate action? The patient's sacral area skin is reddened. The patient is continuously drooling saliva The patient complains of severe pain in the feet. The patient's blood pressure (BP) is 150/82 mm Hg.
The patient is continuously drooling saliva Drooling indicates decreased ability to swallow, which places the patient at risk for aspiration and requires rapid nursing and collaborative actions such as suctioning and possible endotracheal intubation. The foot pain should be treated with appropriate analgesics, the BP requires ongoing monitoring, and the skin integrity requires intervention, but these actions are not as urgently needed as maintenance of respiratory function.
A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage? The patient has a chronic dry cough. The patient has four loose stools in a day. The patient develops a deep vein thrombosis. The patient's blood pressure is 92/52 mm Hg
The patient's blood pressure is 92/52 mm Hg Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use.
A 38-yr-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. What is the best response by the nurse? a. "You will have either periods of attacks and remissions or progression of nerve damage over time." b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c. "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d. "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."
a. Most patients with multiple sclerosis (MS) have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact, but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration, and some may experience only occasional and mild symptoms for several years after onset.
A patient is admitted to the hospital with Guillain-Barré syndrome. She had weakness in her feet and ankles that has progressed to weakness with numbness and tingling in both legs. During the acute phase of the illness, what should the nurse know about Guillain- Barré syndrome? a. The most important aspect of care is to monitor the patient's respiratory rate and depth and vital capacity. b. Early treatment with corticosteroids can suppress the immune response and prevent ascending nerve damage. c. The most serious complication of this condition is ascending demyelination of the peripheral nerves and the cranial nerves. d. Although voluntary motor neurons are damaged by the inflammatory response, the autonomic nervous system is unaffected by the disease
a. The most serious complication of Guillain-Barré syndrome is respiratory failure, and it is essential that respiratory rate and depth, ABGs, and vital capacity are monitored to detect involvement of the autonomic nerves that affect respiration. Corticosteroids do not appear to have an effect on the prognosis or duration of the disease. Rather, plasmapheresis or administration of high-dose immunoglobulin does result in shortening recovery time. The peripheral nerves of both the sympathetic and parasympathetic nervous systems are involved in the disease and may lead to orthostatic hypotension, hypertension, and abnormal vagal responses affecting the heart. Guillain-Barré syndrome may affect the lower brainstem and cranial nerves (CNs) VII, VI, III, XII, V, and X, affecting facial, eye, and swallowing functions.
When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about oral corticosteroids. antiparkinsonian drugs. magnetic resonance imaging (MRI). electroencephalogram (EEG) testing.
antiparkinsonian drugs. The clinical diagnosis of Parkinson's is made when tremor, rigidity, and akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
A patient with a tremor is being evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by a. CT and MRI scans. b. relief of symptoms with administration of dopaminergic agents. c. the presence of tremors that increase during voluntary movement. d. cerebral angiogram that reveals the presence of cerebral atherosclerosis
b. Although clinical manifestations are characteristic in PD, no laboratory or diagnostic tests are specific for the condition. A diagnosis is made when the presence of tremor, rigidity, akinesia, and postural instability occur with asymmetric onset, and it is confirmed with a positive response to antiparkinsonian drugs. Research regarding the role of genetic testing and MRI to diagnose PD is ongoing. Essential tremors increase during voluntary movement, whereas the tremors of PD are more prominent at rest.
A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? a. "It is important for me to avoid exposure to people with upper respiratory infections." b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects." c. "I plan to use vitamin supplements and a diet high in fiber to help manage my condition." d. "I must plan with my family how we are going to manage my care if I become more incapacitated."
b. Corticosteroids used in treating acute exacerbations of MS should not be abruptly stopped by the patient because adrenal insufficiency may result and prescribed tapering doses should be followed. Infections may exacerbate symptoms and should be avoided. High-fiber diets with vitamin supplements are advocated. Long-term planning for increasing disability is also important.
When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient? a. Painful spasticity of the face and extremities b. Retention of cognitive function with total degeneration of motor function c. Uncontrollable writhing and twisting movements of the face, limbs, and body d. Knowledge that there is a 50% chance the disease has been passed to any offspring
b. In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an autosomal dominant genetic disease, HD also has a 50% chance of being passed to each offspring.
Mitoxantrone is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what? a. It must be given subcutaneously every day. b. It has a lifetime dose limit because of cardiac toxicity. c. It is a muscle relaxant that increases the risk for drowsiness. d. It is an anticholinergic agent that causes urinary incontinence
b. Mitoxantrone cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes cardiac toxicity, leukemia, and infertility. It is an immunosuppressant given IV monthly when patients have inadequate responses to other drugs.
A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. What confirms a diagnosis of myasthenia gravis? a. History and physical examination reveal weakness. b. Serum acetylcholine receptor antibodies are present. c. The patient's respiration is impaired because of muscle weakness. d. EMG reveals an increased response with repeated stimulation of muscles.
b. Serum acetylcholine receptor antibodies will confirm a diagnosis of myasthenia gravis (MG). The history and physical revealing weakness is part of the diagnosis, but not the confirmation. Respiration impairment is a sign of MG, but not a confirmation of the diagnosis. The EMG will show muscle fatigue with a decreased response.
The patient is diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) after nerve conduction velocity test. How will this patient with CIDP be treated differently than a patient with Guillain-Barré syndrome? a. Rehabilitation b. Corticosteroids c. Plasmapheresis d. IV immunoglobulin
b. The patient with chronic inflammatory demyelinating polyneuropathy (CIDP) will respond to corticosteroids, and the patient with Guillain-Barré syndrome will not. Both patients will benefit from rehabilitation, plasmapheresis, and IV immunoglobulin.
A patient with Guillain-Barré syndrome asks whether he is going to die as the paralysis spreads toward his chest. In responding to the patient, what should the nurse know to be able to best answer this question? a. Patients who require ventilatory support almost always die. b. Death occurs when nerve damage affects the brain and meninges. c. Most patients with Guillain-Barré syndrome do not die, but recover. d. If death can be prevented, residual paralysis and sensory impairment are usually permanent.
c. As nerve involvement ascends, it is very frightening for the patient, but 80% of patients with Guillain-Barré syndrome recover completely with care, although 65% may have a residual weakness. Patients have a poor prognosis but also recover if ventilatory support is provided during respiratory failure. Guillain-Barré syndrome affects only peripheral nerves and does not affect the brain.
During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a. Tremors, dysphasia, and ptosis b. Bowel and bladder incontinence and loss of memory c. Motor impairment, visual disturbances, and paresthesias d. Excessive involuntary movements, hearing loss, and ataxia
c. Motor impairment, visual disturbances, and paresthesias Specific neurologic dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system. Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesias as well as patchy blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue, are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary movements and tremors are not seen in MS.
A patient with Parkinson's disease is started on levodopa. What should the nurse explain about this drug? a. It stimulates dopamine receptors in the basal ganglia. b. It promotes the release of dopamine from brain neurons c. It is a precursor of dopamine that is converted to dopamine in the brain. d. It prevents the excessive breakdown of dopamine in the peripheral tissues.
c. Peripheral dopamine does not cross the blood-brain barrier, but its precursor, levodopa, is able to enter the brain, where it is converted to dopamine, increasing the supply that is deficient in PD. Bromocriptine is used to treat PD to stimulate dopamine receptors in the basal ganglia. Amantadine stimulates dopamine release and blocks the reuptake of dopamine into presynaptic neurons. Carbidopa and entacapone are agents that are usually administered with levodopa to prevent the levodopa from being metabolized in peripheral tissues before it can reach the brain.
Which observation of the patient made by the nurse is most indicative of Parkinson's disease? a. Large, embellished handwriting b. Weakness of one leg resulting in a limping walk c. Difficulty rising from a chair and beginning to walk d. Onset of muscle spasms occurring with voluntary movement
c. The akinesia of PD prevents automatic movements and activities such as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of PD.
A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do? a. Teach the family members how to care adequately for the patient's needs. b. Encourage the patient to maintain social interactions to prevent social isolation. c. Promote the use of assistive devices so that the patient can participate in self-care activities. d. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy.
c. The main goal in care of the patient with MS is to keep the patient active and maximally functional and promote self-care as much as possible to maintain independence. Assistive devices encourage independence while preserving the patient's energy. No care activity that the patient can do for himself or herself should be performed by others. Involvement of the family in the patient's care and maintenance of social interactions are also important but are not the priority in care.
In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a. Meet the patient's personal care needs. b. Return the patient to normal neurologic function. c. Maximize neurologic functioning for as long as possible. d. Prevent the future development of additional chronic diseases.
c. The nurse can attempt to assist patients in maximizing neurologic function and self-care abilities, alleviate physical symptoms, and prevent complications for as long as possible. Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities and have no cure, with devastating results for patients and families.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a. Mobility b. Nutrition c. Respiratory function d. Verbal communication
c. The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is monitoring and maintaining adequate ventilation.
A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. helping the caregiver explore respite care options. c. promoting physical exercise and a well-balanced diet. d. teaching about the benefits and risks of ablation surgery.
c. promoting physical exercise and a well-balanced diet.
The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching? a. "Even though the symptoms you have are severe, most people recover with treatment." b. "ALS results from excess chemicals in the brain, so symptoms can be controlled with medication." c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."
d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."
The classic manifestations associated with Parkinson's disease is tremor, rigidity, akinesia, and postural instability. What is a consequence related to rigidity? a. Shuffling gait b. Impaired handwriting c. Lack of postural stability d. Muscle soreness and pain
d. The degeneration of dopamine-producing neurons in the substantia nigra of midbrain and basal ganglia lead to these signs. Muscle soreness, pain, and slowness of movement are patient function consequences related to rigidity. Shuffling gait, absent arm swing while walking, absent blinking, masked facial expression, saliva drooling, and difficulty initiating movement are all related to akinesia. Impaired handwriting and hand activities are related to the tremor of Parkinson's disease (PD). Being unable to stop themselves from going forward or backward is from postural instability.
To reduce the risk for falls in the patient with Parkinson's disease, what is the best thing the nurse should teach the patient to do? a. Use an elevated toilet seat. b. Use a wheelchair for mobility. c. Use a walker or cane for support. d. Consciously lift the toes when stepping.
d. The shuffling gait of PD causes the patient to be off balance and at risk for falling. Teaching the patient to use a wide stance with the feet apart, to lift the toes when walking, and to look ahead helps to promote a more balanced gait. Use of an elevated toilet seat will enable a patient to initiate movement but not prevent falls. Using a wheelchair will not maintain independence or optimize psychosocial well-being. Canes and walkers are difficult for patients with PD to maneuver and may make the patient more prone to injury.
The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by a. spinal x-ray findings. b. T-cell analysis of the blood. c. analysis of cerebrospinal fluid. d. history and clinical manifestations
d. There is no specific diagnostic test for MS. A diagnosis is made primarily by history and clinical manifestations. Certain diagnostic tests may be used to help establish a diagnosis of MS. Positive findings on MRI include evidence of at least two inflammatory demyelinating lesions in at least two different locations within the central nervous system (CNS). Cerebrospinal fluid (CSF) may have increased immunoglobulin G and the presence of oligoclonal banding. Evoked potential responses are often delayed in persons with MS.
A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement
d. Uncontrolled head movement Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.
During routine assessment of a patient with Guillain-Barré syndrome, the nurse finds the patient is short of breath. The patient's respiratory distress is caused by a. elevated protein levels in the CSF. b. immobility resulting from ascending paralysis. c. degeneration of motor neurons in the brainstem and spinal cord. d. paralysis ascending to the nerves that stimulate the thoracic area.
d. paralysis ascending to the nerves that stimulate the thoracic area.
When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should assess for the presence of chest pain. inquire about urinary tract problems. inspect the skin for rashes or discoloration. ask the patient about any increase in libido.
inquire about urinary tract problems. Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.
A patient hospitalized with a new diagnosis of Guillain-Barré syndrome has numbness and weakness of both feet. The nurse will anticipate teaching the patient about infusion of immunoglobulin intubation and mechanical ventilation. administration of corticosteroid drugs. insertion of a nasogastric (NG) feeding tube.
insertion of a nasogastric (NG) feeding tube. Because Guillain-Barré syndrome is in the earliest stages (as evidenced by the symptoms), use of high- dose immunoglobulin is appropriate to reduce the extent and length of symptoms. Mechanical ventilation and tube feedings may be used later in the progression of the syndrome but are not needed now. Corticosteroid use is not helpful in reducing the duration or symptoms of the syndrome.
The nurse advises a patient with myasthenia gravis (MG) to perform physically demanding activities early in the day. anticipate the need for weekly plasmapheresis treatments. do frequent weight-bearing exercise to prevent muscle atrophy. protect the extremities from injury due to poor sensory perception.
perform physically demanding activities early in the day. Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.