Nursing of Adults: Neurological Disorders Part II

A patient who has experienced a stroke has expressive aphasia. Which abnormal manner of communication does the patient display?

Can understand the spoken word, but cannot speak.

Which technique is necessary for safely feeding a patient with hemiplegia? (Select all that apply.)

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

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

Gently wipe nose with absorbent gauze.

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Which action is the first autonomic event following a stressful or frightening event?

Heart rate and blood pressure rise, secretion of adrenaline

Which sign is the first sign of Bell's palsy?

Inability to wrinkle forehead and pucker lips on affected side

A frantic family member is distressed about the flaccid paralysis of a relative following a spinal cord injury several hours ago. Which fact does the nurse know about this condition?

It is possibly a temporary condition and will clear.

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. Which position is most appropriate for the patient?

Neck placed in a neutral position.

Which action will the nurse take when caring for a child recently diagnosed with bacterial meningitis?

Place the child in respiratory isolation.

Which is a sign of Cushing response? (Select all that apply.)

Widened pulse pressure Bradycardia Increased systolic blood pressure

The nurse is caring for a patient who had a spinal cord injury at C5 3 years ago. The nurse expects the plan of care will focus on the knowledge that the patient will be able to do which activity independently?

feed self with setup and adaptive equipment.

An 83-year-old patient has had a stroke. The patient is right handed and has a history of hypertension and "little" strokes. The patient presents with right hemiplegia. To afford the patient the best visual field, the nurse will approach the patient in which manner?

from the left side.

Which 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?"

Cerebral Vascular Accident (CVA) • Etiology/Pathophysiology

- Abnormal condition of the blood vessels of the brain • thrombosis • emoblism• hemorrhage - Results in ischemia of the brain tissue - Underlying causes • atherosclerosis, heart disease, hypertension, kidney disease, PVD, DM - Risk factors• obesity, high serum cholesterol, cigarette smoking, stress, cocaine use, and sedentary lifestyle

Meningitis • Etiology/Pathophysiology

- Acute infection of the meninges - Pneumococci, meningococci, staphylococci, streptococci, H. influenzae, and viral - Bacterial or aseptic

Spinal Cord Trauma • Etiology/Pathophysiology

- Automobile, motorcycle, diving, surfing, other athletic accidents, and gunshot wounds - Fracture of vertebra simple, compressed, wedged, comminuted or burst fractures dislocation of vertebrae - Complete cord injury total transection of the spinal cord complete loss of spinal cord function - Incomplete cord injury • partial transection or injury of spinal cord

Intracranial Tumors • Etiology/Pathophysiology

- Benign or malignant - Primary or metastatic - May affect any area of the brain

Trigeminal Neuralgia (Tic Douloureux) • Etiology/Pathophysiology

- Degeneration of or pressure on the trigeminal nerve

Guillain-Barre' Syndrome • Etiology/Pathophysiology

- Inflammation and demyelination of the peripheral nervous system - Cause is unknown - Possibly viral or autoimmune reaction

Bell's Palsy (peripherial facial paralysis) • Etiology/Pathophysiology

- Inflammatory process involving the facial nerve - Vasoconstriction due to ischemia, edema, or emotional trauma may also be a cause - Unilateral or bilateral

Craniocerebral Trauma (Head Injury) • Etiology/Pathophysiology

- Motor vehicle and motorcycle accidents, falls, industrial accidents, assaults, and sports trauma - Direct trauma head is directly injured acceleration-deceleration injury bruising or contusion of the occipital and frontal lobes and brainstem and cerebellum - Indirect trauma • Tension strains and shearing forces transmitted to the head by stretching of the neck - Open head injuries Skull fractures Penetrating wounds - Closed head injuries • Concussions - violent jarring of the brain against the skull • Contusions • Lacerations - Hematomas • scalp, epidural, subdural, intracerebral, and intraventricular - epidural and subdural must be monitored carefully

Huntington's Disease • Etiology/Pathophysiology

- Over activity of the dopamine pathways • opposite of Parkinson's - Genetically transmitted

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 term would best describe the patient's inability to assess spatial position of his body?

Loss of proprioception

Which factor 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.

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." Which action will be the initial nursing intervention based on these signs?

Sit upright and check blood pressure.

For which reason is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately?

The disease can rapidly progress into respiratory failure.

A patient has recently experienced a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. Which nursing interventions would be most helpful in assisting this patient to swallow safely?

Tuck chin when swallowing.