S3 U1

Why is LOC the most reliable indicator of mental status?

it has extreme sensitiviy o oxygen levels in the cerebral blood. As ICP increases, and perfusion is reduced, oxygen delivery is also reduced.

Decerebrate posturing means damage to?

mid-brain, upper pons(brainstem)

What is the earliest sign of change in motor function?

motor drift

What is the cause of myasthenia gravis?

Myasthenia Gravis *Attacks ACTH (Acetylcholine) receptors at the Neuromuscular Junction*. tumor: is THYMOMA - weakness in muscles.

(ICP) What is Cushing's triad?

hypertension, bradycardia and widening pulse pressure

What are the normal characteristic of CSF?

-pressure 50 to 175 mm H2O -pH 7.30 to 7.40 -clear, colorless appearance; -fasting glucose 40 to 80 mg/dL -white blood cells 0 to 5 small lymphocytes/mm3.

What is normal ICP?

0-15 mm Hg

The nurse is planning care for a client in spinal shock. Which action would be least helpful in minimizing the effects of vasodilation below the level of the injury? 1. Moving the client quickly as one unit 2. Using vasopressor medications, as prescribed 3. Applying compression stockings, as prescribed 4. Monitoring vital signs before and during position changes

1

The client with spinal cord injury suddenly experiences an episode of autonomic dysreflexia. After checking vital signs, which immediate action should the nurse take? 1. Raise the head of the bed and remove the noxious stimulus. 2. Lower the head of the bed and remove the noxious stimulus. 3. Lower the head of the bed and administer an antihypertensive agent. 4. Remove the noxious stimulus and administer an antihypertensive agent.

1 Key nursing actions are to sit the client up in bed, remove the noxious stimulus, and bring the blood pressure under control with antihypertensive medication per protocol.

The nurse is providing care to a client with increased intracranial pressure (ICP). Which approaches would be beneficial in controlling the client's ICP from an environmental viewpoint? Select all that apply. 1. Reducing environmental noise 2. Maintaining a calm atmosphere 3.Allowing the client uninterrupted time for sleep 4.Clustering nursing activities to be done all at once 5.Keeping overhead lights on most of the day and night

1,2,3

The nurse is monitoring a client with a C5 spinal cord injury for spinal shock. Which findings would be associated with spinal shock in this client? Select all that apply. 1. Bowel sounds are absent. 2. The client's abdomen is distended. 3. Respiratory excursion is diminished. 4. The blood pressure rises when the client sits up. 5. Accessory muscles of respiration are areflexic.

1,2,3,5

What are ways to improve mobility for a patient with Parkinson disease? Select all that apply. 1. Scoot to the edge of a chair before trying to stand 2. March in place before starting to walk 3. Use cotton sheets to make it easier to move in and out of bed 4. Practice lifting the foot as if to step over an object on the floor to initiate walking.

1,2,4

In order to reduce the symptoms of Parkinson disease, what is L-dopa converted to as it crosses the blood-brain barrier? 1. Epinephrine 2. Dopamine 3. Norepinephrine 4. Acetylcholine

Dopamine

Which data collection finding supports the possible diagnosis of Bell's palsy?

1. Burning pain in the nose with intermittent facial paralysis 2. Speech or chewing difficulties accompanied by facial droop 3. Stabbing facial pain with intermittent tingling sensations in the eyes 4. Tingling sensations of the eyelid, in addition to decreased lacrimation

What happens if perfusion pressure falls to 40 mm Hg?

Ischemia

The most accurate and reliable indicator of neurologic status is the _______

LOC

What is a fully alert GCS score? When would you intubate?

15. intubate when its less than 8.

The nurse has provided discharge instructions to a client with an application of a halo device. The nurse determines that the client needs further teaching if which statement is made? "I will use a straw for drinking." 2."I will drive only during the daytime." 3. "I will use caution because the device alters balance." 4."I will wash the skin daily under the lamb's-wool liner of the vest."

2

The nurse observes the unlicensed assistive personnel (UAP) positioning the client with increased intracranial pressure (ICP). Which position would require intervention by the nurse? 1. 3Head midline. 2. Head turned to the side 3. Neck in neutral position 4. Head of bed elevated 30 to 45 degrees

2

A client has experienced an episode of myasthenic crisis. The nurse collects data to determine whether the client has experienced which precipitating factor? 1. Too little exercise 2. Omitted doses of medication 3. Increased doses of medication 4. Decreased intake of fatty foods

2 Myasthenic crisis is often caused by undermedication and responds to administration of cholinergic medications such as neostigmine and pyridostigmine. Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications.

A client in the emergency department is diagnosed with Bell's palsy. The nurse collecting data on this client expects to note which observations? Select all that apply. 1. Double vision 2. Excessive tearing 3. Inability to furrow brow 4. Pain in cheek, jaw, and teeth 5. Altered level of consciousness 6. A lag in closing the bottom eyelid

2,3,6

The nurse is teaching the client with myasthenia gravis about prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by which activity? 1. Eating large, well-balanced meals 2. Doing muscle-strengthening exercises 3. Doing all chores early in the day while less fatigued 4. Taking medications on time to maintain therapeutic blood levels

4

The nurse is caring for the client who has suffered spinal cord injury. The nurse further monitors the client for signs of autonomic dysreflexia and suspects this complication if which sign/symptom is noted? 1. Sudden tachycardia 2. Pallor of the face and neck 3. Severe, throbbing headache 4. Severe and sudden hypotension

3

The nurse is collecting data on a client with myasthenia gravis. The nurse determines that the client may be developing myasthenic crisis if the client makes which statement? 1. "I took my pills late last night." 2. "I can hardly think straight today." 3. "I can't swallow very well today." 4. "I dropped one of my pills on the floor."

3

What is a late sign of increased ICP due to pressure on the third cranial nerve? 1. Jerky tracking of eyes 2. Altered motor function 3. Dilated pupils 4. Hemiparesis

3

A type of headache associated with possible auras, pain and sensitivity to light and sound.

Migraine

Perfusion pressure may be better preserved if the head of the bed is elevated no more than?

30 degrees

A client with myasthenia gravis is experiencing prolonged periods of weakness. The primary health care provider prescribes a test dose of edrophonium and the client becomes weaker. The nurse interprets this outcome as indicative of which result? 1. Normal 2. Positive 3. Myasthenic crisis 4. Cholinergic crisis

4

The client recovering from a head injury is arousable and participating in care. The nurse determines that the client understands measures to prevent elevations in intracranial pressure (ICP) if the nurse observes the client doing which activity? 1. Blowing the nose 2. Isometric exercises 3. Coughing vigorously 4. Exhaling during repositioning

4

The client with a cervical spine injury has Crutchfield tongs applied in the emergency department. The nurse should perform which essential action when caring for this client? 1. Providing a standard bed frame 2. Removing the weights to reposition the client 3. Removing the weights if the client is uncomfortable 4. Comparing the amount of prescribed weights with the amount in use

4

The client with spinal cord injury is prone to experiencing autonomic dysreflexia. The *least* *appropriate* measure to minimize the risk of autonomic dysreflexia is which action? 1. Strictly adhering to a bowel retraining program 2. Keeping the linen wrinkle-free under the client 3. Avoiding unnecessary pressure on the lower limbs 4. Limiting bladder catheterization to once every 12 hours

4

The nurse is caring for a client with increased intracranial pressure (ICP). Which change in vital signs would occur if ICP is rising? 1. Increasing temperature, increasing pulse, increasing respirations, decreasing BP 2. Decreasing temperature, decreasing pulse, increasing respirations, decreasing BP 3. Decreasing temperature, increasing pulse, decreasing respirations, increasing BP 4. Increasing temperature, decreasing pulse, decreasing respirations, increasing BP

4

A type of headache in which the pain is usually unilateral and has a warning is called: 1. cluster 2.migraine 3.tension 4.sinus

Migraine

A chronic, progressive disease in which the amount of acetylcholine available at the neuromuscular junction is reduced

Myasthenia Gravis

What minimum perfusion pressure must be reached for adequate cerebral functioning?

70 mm Hg

What is the treatment for Cholinergic Crisis?

Atropine Sulfate

Acute paralysis of the seventh cranial nerve

Bell's Palsy

Treatment consist of closing and patching the eye if it loses the blink reflex, artificial tear eye drops to prevent dryness of the cornea, Corticosteroids at beginning of symptom

Bell's Palsy

Type of headache that has no warning symptoms, occurs in a series of episode followed by a long period with no symptoms. Intensely painful and related to stress of anxiety.

Cluster

A sudden exacerbation of myasthenic symptoms, including difficulty swallowing and breathing, with possible respiratory arrest. Infection often precipitates the event and symptoms do not decrease even with increased doses of medications.

Myasthenic Crisis

A progressive degenerative disease that results in an eventual loss of coordination and control over involuntary motor movement

Parkinsons

Type of headache resulting from prolonged muscle contraction associated with anxiety, stress, or stimuli from other sorces such as a brain tumor, or an abscessed tooth.

Tension

What does the Monro-Kellie hypothesis describe?

The adaptations that must occur in the 3 components of ICP to remain normal.

What is characteristic of the tremors of a patient with Parkinson syndrome?

Tremors are more pronounced at rest & are often relieved by movement

ICP evokes an increase in sysolic pressure with little or no associated increase in diastolic blood pressure. This results in what?

Widening pulse pressure.

What is autonomic dysreflexia?

an exaggerated response of the autonomic nervous system to some noxious (painful) stimuli.

Treatment for tension headaches?

analgesic, muscle relaxants, massage

As pressure rises, the pupil progresses from its normal size to a dilated state known as

blown pupil. the pupil becomes dilated and fixed and no longer reacts to light. These changes occur because of pressure on the oculomotor nerve (third cranial nerve) This is a late sign of increased ICP.

What are the components that exert pressure in the cranium?

brain, blood, CSF

What do descending tracts do?

carry motor information from the the brain to the spinal cord

What do ascending tracts do?

carry sensory information from the spinal cord to the brain

What is the earliest changes seen in ICP?

changes in LOC

What are the late signs of increasing ICP?

changes in pulse, respiratory rate, blood pressure

In Myasthenia Gravis, muscles responsible for fine mmovements such as the eye, facial or hand muscles are often affected early in the disease process. What is ptosis?

characteristic of Myasthenia Gravis where

What should we do with otorrhea or rhinorrhea? Test to determine if there is CSF leak...

collect about a tsp on white gauze and look for yellow ring or halo will form around the CSF

deficits on opposite side from brain injury

contralateral to the injury

As oxygen delivery to cerebral tissue becomes more impaired, the level of carbon dioxide in the tissue increases. Increased carbon dioxide leads to dilation of cerebral blood vessels, thereby increasing the blood volume and ICP. What can be done?

controlled hyperventilation to eliminate excess carbon dioxide.

Decorticate posturing means damage to?

cortex

What does L-dopa do for Parkinsons?

it crossed the blood-brain barrier and converts to dopamine in the basal ganglia, thereby supplementing levels of the neurotransmitter and reducing the symptoms of the disease.

As increased pressure becomes more extensive, abnormal posturing may occur. As increased pressure is exerted on the cerebral tissue of the midbrain and pons, abnormal extension or _________ is observed.

decerebrate posturing

As increased pressure becomes more extensive, abnormal posturing may occur. As increased pressure is exerted on the cerebral tissue above the midbrain, a patter know as abnormal flexion or ________ is observed.

decorticate posturing

The brain depends on constant supplies of glucose and other nutrients. Disturbances in glucose metabolism and electrolyte imbalances can lead to

deterioration in thought processes and level of consciousness.

The spinal cord is surrounded by 3 protective meningeal layers. What are they?

dura mater, arachnoid, pia mater

Parkinson's involves a decrease in the dopamine neurotransmitters and increase in acetylcholine neurotransmitters. This increase causes what?

excessive excitation of neurons .prevents a person from controlling or initiating voluntary movements.

Review of systems for the Neurological Patient:

fatigue or *weakness*, *headache*, dizziness, vertigo, changes in vision/hearing, tinnitus, *drainage from ears/nose*, dysphagia, neck pain or stiffness, vomitting, *bladder or bowel changes*

Stress triggers the sympathetic nervous system to increase the secretion of epinephrine and norepinephrine. These neurotransmitters increase heart rate and constrict peripheral blood vessels, causing the blood pressure to rise. This reaction to stress is called

fight or flight response

Neuromuscular function tests include?

hand grasps, gait, equal strength lower and upper

How do you perform the Romberg's test?

have the patient stand with feet together and arms at his or her sides. Instruct the patient to close their eyes and maintain that position (while you stay close by in case the patient starts to fall). Normally the patient will display only slight swaying.

(Parkinson's Treatment-Depression) St John's wort is an antidepressant. It is an monoamine oxidase(MAO) inhibitor. and can interact with prescribed drugs. As the patient to report the use of what?

herbal remedies without being approved by the physician.

(Treatment of ICP) What is mannitol?

hyperosmolar diuretic that draws edema fluid from the tissue spaces into the bloodstream

Parkinson's Meperidine + MAOI =

hyperpyrexia (excessive elevation of temperature) and possible death

In a patient with myasthenia gravis, what does rapid improvement of muscle strength after administration of edrophonium chloride (Tensilon) indicate? 1. Hypertensive crisis 2. Adrenergic crisis 3. Myasthenic crisis 4. Cholinergic crisis

myasthenic crisis

What are age related changes to the spinal cord?

number of nerve cells decreases, brain weight is reduced, ventricles increase in size. *eye pupil often smaller* *may respond to light more slowly*. *reaction time increases* *problems with balance*

What causes Cholinergic Crisis?

overdose of the medication to treat myasthenia gravis i.e. pyridostigmine (Mestinon)

Immediately after SCI, the pt will have?

patient will have flaccid type of paralysis -later as cord adjusts to injury paralysis becomes spastic with strong involuntary contractions of skeletal muscles. -muscle spasms can be strong enough to throw patient out of bed or wheelchair. -patient must be secured so no injury occurs. --patient and family may interpret as return of voluntary function of limbs and will have false hope of complete recover...nurse must explain that these are frequently seen in patients with spinal injuries and to avoid stimulating the muscles when moving the patient to decrease the frequency of spams. -avoid grasping the muscle itself...utilize the palms of the hands to support the joint above and below the affected muscles... -antispasmodics i.e. baclofen can be administered

Movement associated with the tremor that repeated moves the thumb against the fingers

pill rolling

What are measures to lower ICP?

position changes, hyperventilation, fluid management, mechanical drainage, drug therapy.

Although it is extremely important to monitor vital signs in the neurologic patient. remember that changes in ______, __________ ________, and ______ ______ are late signs of increasing ICP

pulse, respiratory pattern and blood pressure

As ICP compresses the tissue around the hypothalamus, it becomes ischemic and unable to do what?

regulate body temperature.

A subtle weakness in upper arm strength is assessed by having the patient extend both arms forward with the palms up. Ask the patient to close his or her eyes and maintain the position for 10 to 20 seconds. With normal strength, the arms remain steady. In the presence of a slight weakness, the weak arm will do what? and whar is this referred to?

rotate internally and drift slightly downward. This is referred to as ulnar or motor drift

If a patient is stuporous but can be aroused, the patient is ______

semicomatose

Dysphagia- check that patient automatically swallows saliva before give water... patient with dysphagia are at risk for nutritional deficits and aspiration pneumonia What do you do for a patient with dysphagia?

sit them upright and high fowlers

With a widening pulse pressure, the heart rate may be slightly accelerated initially. However, as ICP compresses the center for cardiac control in the brainstem, the heart rate becomes

slow and irregular

When assessing the neurologic patient, be sure to assess what 5 things?

speech, behavior, coordination, alertness, comprehension

Injury that does not involve complete severance of the cord may result in a __________ ___________, which may subside as the spinal cord recovers from swelling and initial shock of the injury

temporary paralysis

How is myasthenia gravis diagnosed?

tensillon test. sxs improve with Edrophonium .

What are the four common types of headaches?

tension, migraine, cluster, disorder related

In myasthenia gravis, insufficient receptor sites exist at the junction of the motor nerve with the muscle. With repeated stimulation what happens?

the muscle becomes exhausted and eventually unable to contract at all.

What is a positive Rombergs test?

the patient sways from side to side.

Cushing Triad is generally associated with increased ICP, but it is unreliable in determining what?

the severity of neurologic compromise

What is the cornerstone of therapy for Parkinsons?

the use of L-dopa.

What effect do the drugs Neostigmine and Pyridostigmine have on the neuromuscular junction?

they increase the availability of acetylcholine at the neuromuscular junction. Both drugs inhibit the action of cholinesterase, the enzyme that destroys acetylcholine. The availability of acetylcholine is improved, thereby enhancing muscle strength.

What are the major triad of symptoms for Parkinsons?

tremor, ridgity (stiffness), bradykinesia,

A specialized catherter can be placed in the brain to drain excess CSF. What is it called?

ventriculostomy

What types of muscles does myasthenia gravis affect?

voluntary muscles

Myasthenia Gravis is characterized by what?

weakness of voluntary muscles(particularly those of chewing, swallowing and speaking), and partial improvements of strength with rest, and dramatic improvement w/ the use of anticholinesterase drugs.