Adult Final Exam -- Unit 6

Huntington's Disease Clinical Manifestations

-Chorea: rapid, jerky, involuntary, purposeless movements (doesn't go away with movement and may be present during sleep) -Difficult to chew and swallow -Disorganized gait Intellectual decline (memory problems, severe dementia) -Behavioral and emotional changes( nervousness, irritability, depression/suicidal, impaired memory/judgment (cannot be left alone) -Bowel and bladder control loss and increase in appetite but difficulty eating

Myasthenia Gravis (MG) Clinical Manifestations

-Motor disorder -Ocular muscle involvement >>Normally early sign; sometimes only sign >>Diplopia >>Ptosis General Form >>Weakness of face & throat: "bulbar" weakness (Dysphagia, dysphonia, blank expression) >>Generalized weakness, limb weakness >>Respiratory weakness>respiratory failure (can get lung muscle)

Huntington's Disease Pathophysiology

-Progressive and chronic hereditary dz of the NS (autosomal dominant 50/50) -Loss of cells in the striatum of the basal gangic and cortex

Stroke Managment

-Prompt diagnosis and treatment! (within one hour) -Assessment (full neuro assessment- go back over cranial nerves), perfusion, motor function, monitor bp >>NIHSS (21-42= severe stroke) -Nutrition: speech therapist to assess swallowing/to help heal; no PO meds until speech has seen patient; THINK ASPIRATION; put an NG tube (think ab NG tube care- get x-ray before using -Bladder and bowel control: give a high fiber, get bladder scan before cathing, skin integrity due to incontinence, stool softeners and laxatives (especially for those with increased ICP so no straining) -Positioning: turn every 2 hours; do not leave on affected side too long ( most complain of shoulder pain on affected side); prevent contractures (towel roll, ROM), -Communication: communication boards, be patient, be sensitive -Collaborative care: speech, PT, OT, social work (most will need rehab) -Enhancing self-care + coping: encourage independence (using the unaffected side), treat the affected side first and then the strongest side (ie. dressing)

Amyotrophic Lateral Sclerosis (ALS) Pathophysiology

-Unknown cause -Loss of upper/lower motor neurons and motor nuclei (motor neuron disease) -Heredity, men slightly more common, autoimmune conditions, toxin exposure, smoking, viral infection -Referred to as Lou Gehrig's Disease or Motor Neuron Disease

Cerebrovascular Disorders CoursePoint Questions

1. A nurse is instructing the spouse of a client who suffered a stroke about the use of eating devices the client will be using. During the teaching, the spouse starts to cry and states, "One minute he is laughing, and the next he's crying; I just don't understand what's wrong with him." Which statement is the best response by the nurse? "Emotional lability is common after a stroke, and it usually improves with time." 2. The client with a cerebral aneurysm asks the nurse, "What's the big fuss over a headache?" Which is the best response from the nurse regarding to a cerebral aneurysm? "Your physician wants to evaluate the location and condition of the aneurysm." 3. Which of the following is the initial diagnostic in suspected stroke? Non-contrast computed tomography (CT) 4. Which clinical manifestation would be exhibited by a client following a hemorrhagic stroke of the right hemisphere? Neglect of the left side 5. A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following? Thrombolytic therapy has a time window of only 3 hours. 6. A patient is brought to the emergency department with a possible stroke. What initial diagnostic test for a stroke, usually performed in the emergency department, would the nurse prepare the patient for? Non-contrast commuted tomography (CT) 7. During a class on stroke, a junior nursing student asks what the clinical manifestations of stroke are. What would be the instructor's best answer? "Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation." 8. The nurse is caring for a client with dysphagia. Which intervention would be contraindicated while caring for this client? Placing food on the affected side of the mouth 9. The nurse recognizes health promotion efforts to decrease the risk for ischemic stroke involve encouraging a healthy lifestyle, including a low-fat, low-cholesterol diet and increased exercise. 10. After the patient has received tPA, the nurse knows to check vital signs every 30 minutes for 6 hours. Which of the following readings would require calling the provider? Diastolic pressure of 110 mm Hg 11. What clinical manifestations does the nurse recognize when a patient has had a right hemispheric stroke? Left visual field deficit 12. The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? Semi-Fowler's 13. The nurse is caring for a client diagnosed with a hemorrhagic stroke. The nurse recognizes that which intervention is most important? Maintaining a patent airway 14. Which interventions would be recommended for a client with dysphagia? Assist the client with meals, test the gag reflex before offering food or fluids, and allow ample time to eat 15. An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The treatment window for thrombolytic therapy is which of the following? Three hours 16. An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The treatment window for thrombolytic therapy is which of the following? Tissue plasminogen activator (tPA) 17. A patient is admitted via ambulance to the emergency room of a stroke center at 1:30 p.m. with symptoms that the patient said began at 1:00 p.m. Within 1 hour, an ischemic stroke had been confirmed and the doctor ordered tPA. The nurse knows to give this drug no later than what time? 4:00 p.m. 18. A client is hospitalized when presenting to the emergency department with right-sided weakness. Within 6 hours of being admitted, the neurologic deficits had resolved and the client was back to his pre-symptomatic state. The nurse caring for the client knows that the probable cause of the neurologic deficit was what? Transient ischemic attack (TIA) 19. Which of the following is the most common side effect of tissue plasminogen activator (tPA)? Bleeding 20. A client has experienced an ischemic stroke that has damaged the lower motor neurons of the brain. Which of the following deficits would the nurse expect during assessment? Lack of deep tendon reflexes 21. When should the nurse plan the rehabilitation of a patient who is having an ischemic stroke? The day the patient has the stroke 22. If warfarin is contraindicated as a treatment for stroke, which medication is the best option? Aspirin 23. The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is: Hypertension 24. An emergency department nurse is interviewing a client who is presenting with signs of an ischemic stroke that began 2 hours ago. The client reports a history of a cholecystectomy 6 weeks ago and is taking digoxin, warfarin, and labetalol. What factor poses a threat to the client for thrombolytic therapy? International normalized ratio (INR) greater than 2

Neurological Disorders Questions

1. A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: rest in an air conditioned room. 2. The diagnosis of multiple sclerosis is based on which test? Magnetic resonance imaging (MRI) 3. The nurse provides care for a client who is diagnosed with Parkinson disease (PD) and newly prescribed levodopa. Which safety instruction should the nurse provide to the client to decrease the risk for falling? "Get up slowly to avoid dizziness that can be caused by hypotension." 4. Which of the following is considered a central nervous system (CNS) disorder? Multiple sclerosis 5. The nurse provides care for a client who is newly prescribed an anticholinergic medication for the treatment of Parkinson disease. Which is the priority teaching point to decreasing the client's risk for falling in the home environment due to the prescribed medication? "Change positions slowly when getting up in the morning." 6. Which client statement indicates to the nurse a need for further education regarding prescribed therapies, such as carbidopa-levodopa, for the treatment of Parkinson disease? Select all that apply. "I will not have tremors if I take my medication consistently." "I understand that this medication will take less than a week to reach effectiveness." "I will consume a diet high in carbohydrates and protein to enhance absorption." Meals that are high in protein should be avoided because they interfere with the absorption of the prescribed medication; therefore, this client statement indicates a need for additional teaching. 7. The nurse provides care to a client who is newly diagnosed with Parkinson disease. Upon entering the client's room, the nurse finds the spouse crying and visibly upset by the new diagnosis. Which is the best response by the nurse? "Let's talk about how you feel about the diagnosis. It must be alarming." 8. The nurse provides care for a client who is prescribed carbidopa-levodopa for the treatment of Parkinson disease. Which assessment finding indicates that the medication is having the desired effect? Steady gait with movements that are fluid. 9. Which statement made by the spouse of a client who is diagnosed with Parkinson disease will be most helpful for fall prevention? Remove clutter such as loose rugs and install grab bars in bathrooms. 10. A client with advanced Parkinson disease and dementia tell the nurse, "I've been in this nursing home for 3 years. I want to go home today!" Which response by the nurse is appropriate? "Let's talk about how your life would change if you went home." 11. The nurse provides care for a client who is diagnosed with multiple sclerosis (MS) and newly prescribed interferon beta. Which instruction is most important to include in the medication teaching session due to the client's increased risk for infection? "Avoid crowds and be sure to wash your hands or use hand sanitizer frequently." 12. A client who is diagnosed with Parkinson disease (PD) is prescribed levodopa. Which food choice should the nurse instruct the client to eat in moderation due to food-drug interactions associated with the prescribed levodopa? Bananas Foods that are rich in pyridoxine, or vitamin B6, can interfere with the effectiveness of levodopa; therefore, bananas should not be consumed in large volumes in the client's diet. 13. The nurse provides health promotion instruction for a client who is diagnosed with multiple sclerosis (MS) and prescribed interferon injections. Which client statement indicates a need for additional education? "Loss of appetite and nausea are expected side effects." No because it can be associated with liver damage, an adverse reaction of the prescribed medication 14. While providing self-care instructions to the client diagnosed with multiple sclerosis, which intervention will the nurse instruct the client to implement to decrease the occurrence of fatigue? Avoid exercises and activities that result in body overheating 15. The client who is diagnosed with Parkinson disease (PD) is on multiple medications, including benztropine. When providing education to the client regarding the management of PD, which information should the nurse provide to address the anticholinergic side effects of the benztropine? Select all that apply. "Chewing sugar free gum helps to moisten your mouth." "Increasing foods that are rich in fiber is important to decrease constipation." "Be sure to monitor your intake and output as urinary retention may occur due to your prescribed medication." "Taking a walk everyday is a strategy to address constipation." 16. A client with Parkinson's Disease is admitted to the long-term care facility with a BMI of 19 and is having difficulty swallowing. Which referral is appropriate for the nurse to seek? Speech therapy because the client needs a swallowing study 17. The nurse conducts a home visit for a client who has end-stage Parkinson disease (PD). Which observation prompts the nurse to provide the caregiver with psychosocial support? The caregiver states, "These new medications aren't helping at all. I don't know why I bother giving them." 18. As the nurse works with the client in the early stage of Parkinson's disease, which intervention will the nurse educate the client to implement while maintaining optimal health? "It is best to take your time as you complete your daily bathing and feeding." 19. Which teaching will the nurse provide to a client with Parkinson's disease to prevent aspiration? Select all that apply. Take small bites and chew completely before swallowing. Avoid eating foods that are harder to chew, such as steak. Position upright while eating, and for 10 to 20 minutes after. 20. A nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by: a lower motor neuron lesion. 21. How can the nurse prevent continuous moisture on the skin of a patient who is at risk for developing skin breakdown? Practice meticulous hygiene measures. 22. A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? Help the client perform range-of-motion (ROM) exercises every 8 hours. 23. The nurse is performing an initial assessment on a client who is admitted to rule out myasthenia gravis. Which of the following findings would the nurse expect to observe? Ptosis and diplopia 24. A nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by: Diplopia and ptosis 25. A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? Suction machine with catheters 26. A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? Edrophonium (Tensilon) 27. A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: a positive edrophonium (Tensilon) test. 28. A nurse is describing the concept of rehabilitation to a group of families who have members in need of these services. Which statement would the nurse include in the description? "Rehabilitation focuses on the person's abilities." 29. Which nursing intervention is the priority for a client in myasthenic crisis? Assessing respiratory effort 30. An elderly woman diagnosed with osteoarthritis has been referred for care. The client has difficulty ambulating because of chronic pain. When creating a nursing care plan, what intervention will best promote the client's mobility? Administer an analgesic as prescribed to facilitate the client's mobility. 31. A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? Edrophonium (Tensilon)

A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose?

10mL

Amyotrophic Lateral Sclerosis (ALS) Clinical Manifestations

>Fatigue, progressive muscle weakness, cramps, fasciculations (twitching) and incoordinations >brisk/over reactive reflexes >anal/bladder nerves not affected >Difficulty talking, swallowing, and breathing >Complications: dehydration/malnutrition, pneumonia, resp failure

Multiple Sclerosis (MS) Clinical Manifestations

>Fatigue: most disabling and common >Weakness: voluntary muscle weakness (any muscle in body) >Depression >Paresthesias/numbness >Spasticity - muscle hypertonicity (90%) >Ataxia - Difficulty with coordination; tremor >Loss of balance, vertigo, tinnitus >Pain >Visual disturbance/ diplopia/ blindness >Bowel/bladder and sexual dysfunction >Paralysis >Some degree of cognitive & emotional change -vary from person to person (how progress and where in the brain they have those lesions)

Hemorrhagic Stroke Medications and Surgery

>analgesics >anti-hypertensives >anti convulsants: keppra, phenytoin (Dilantin)- given prophylactic >craniotomy- open op and take part of skull and take some blood out, and put still back; craniectomy (when they leave the skull out) >interventional neuroradiology

Ischemic Stroke Complications

Motor loss, communication loss (left side usually- expressive, recpetive aphasia), perceptual disturbances, sensory loss, cognitive impairment, psychological effects (frustration/depression)

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse?

"If one parent has the disorder, there is a 50% chance that you will inherit the disease"

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response?

"Treatment aims at keeping you independent as long as possible"

Parkinson's Disease Pathophysiology

-Reduction in dopamine in the brain (neurologic movement disorder) -Acetylcholine and dopamine imbalance -Destruction of dopaminergic neural cells in the substantia nigra in the basal gangli—> depletion of dopamine stores—>degeneration of dopaminergic nigrostrital pathways—>imbalance in acetylcholine and dopamine—>impairment of extrapyramidal tracts controlling complex body movements -Risk factors: middle age (50s), male, genetics, brain trauma, environmental exposure, viral infection, atipsychotic meds (parkinsonism), arteriosclerosis

Ischemic Stroke Medications and Surgery

>Anticoagulants, antiplatelets, statins, anti-hypertensives (we want high BP), TPA >carotid endarterectomy (cut open artery and suck out atherosclerosis (plaque)- assess AIRWAY (hematoma presses on airway), neuro assessment); carotid stenting

Stroke Diagnosis

>CT (first one) >CT angiography (usually with hemorrhagic; go in and insert contrast/dye and show vessels of brain) >MRI (when pt is stable) >transcranial doppler flow studies >transesophageal echocardiography >12-lead EKG (for arrhythmias) >carotid ultrasound

Parkinson's Disease Clinical Manifestations

>Diagnosed by 2/4 cardinal symptoms -Tremors: unilateral, pronation/supination/pill rolling; present at rest, better with purposeful movement/sleeping; bad when anxious -Rigidity: stiffness to passive movement, arm legs, facial; red pipe/cognwheel -Bradykinesia: slow movement of active, intentional movement; akinesia (no movement, flacid) -Postural instability: unbalance posture; compensates by hunching over; loss of postural reflexes; high risk for falls -Can also have autonomic symptoms (flushing, sweating, drop in bp, GI/GU sexual dysfunction) and -psychiatric changes (depression, dementia, delirium, auditory and visual hallucinations) -Shuffle gait, micrographia, mask-like ace, corneal abrasions, disphonia, dysphagia and drooling.

Parkinson's Disease Assessments, Nursing, Teachings, and Diagnosis

>Improve functional ability (remember to keep straight posuture) >Maintain independence in ADLs - OT (use equipment, home/work modifications, grab bar for a toilet) >Adequate bowel elimination (may have bad constipation, they dont exercise or drink water, increase fiber AND water intake, >Acceptable nutritional status (give them as much time as possible to eat) -Semisolid diet, thick liquids -Upright for all meal times -put thicken up in beverages to thicken and make it easier for them to swallow >Effective communication (especially if facial complications, can have amplifiers) >Coping skills (OT, recreation, non-judgmental attitude); keeping active is very important >Daily program of exercise (PT) >Stretching & ROM exercises >Postural exercises >Consultation with physical therapy >Walking techniques for safety & balance (tend to look down at shoes instead of ahead) >Frequent rest periods >Use of assistive devices PRN >may have bladder training, enhance swallowing(speech therapy) Assessment: o Degree of disability and function o Medication § Responses and side effects o Emotional response and cooping (individual and family) o Home care and teaching o Fall risk assessment o Potential complications and manifestations

Identify complications of obesity and health implications

>Increased risk for disease disorders, low self-steem, impaired body image, depression, and diminised quality of life >Obesity is associated with 6‐ to 20‐year decrease in life expectancy >Risk for cancer increases with increased BMI >Likelihood of type 2 diabetes by 10-fold >Asthma or hypertension by four-fold >Twice as likely to have Alzheimer's >Increased risk for heart disease, stroke, mental health problems, OSA, fatty liver disease, OA, MI, gout >Impaired immune function; decrease lung capacity and reserve

Amyotrophic Lateral Sclerosis (ALS) Nursing Interventions

>To maintain or improve function, well-being and quality of life >Provide emotional & psychological support >Maintain independence >Communication ROM exercises (to prevent contractures) >Reposition, provide skin care & assist with ADL's >Medications >PEG/ mechanical ventilation -death is usually bc of infection/aspiration Management: o Managed at home and in the community, hospitalization for acute problems o Early recognition of dehydration, malnutrition, pneumonia, respiratory failure o End of life issues: Pain, dyspnea, delirium § End of life decision making is key § Most will qualify for hospice unless they decide to pursue alternate end of life plans o Mechanical ventilation & PEG tube feedings needed eventually, if they choose

Huntington's Disease Nursing Interventions

>diagnosed by genetic markers/history and clinical presentations- treated with tetrabenazine for chorea) -Fall risk interventions (specially is gait is impaired) -Skin care -Optimize nutritional status -May need consults, PEG feeding for nutritional support give them a lot of time to eat -Enhance communication (assume they hear you and understand you even if not) -Home environment -Psychosocial interventions - reorient, listen to music, encourage visitations, train volunteers

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease?

Drugs administered may cause a wide variety of adverse effects

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

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan?

How to facilitate tasks such as using both hands to hold a drinking glass

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity?

Hypertension, coronary artery disease, heart failure, and myocardial infarction

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms?

Parkinson's disease

A client newly diagnosed with Huntington disease asks for information concerning management of symptoms. Which action would the nurse first take to address this request?

Perform a focused assessment on the client's needs and capabilities

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits?

Rapid, jerky, involuntary movements

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring?

Riluzole

A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for?

Suicidal ideations

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following?

The disease has entered the late stages.

Myasthenia Gravis (MG)

antibody mediated breakdown of acetylcholine at neuromuscular junction (impaired transmission and voluntary muscle weakness) -Myasthenic crisis (too little meds) and cholinergic crisis (too much meds) Diagnostics: >>acetylcholinesterase inhibitor test (edrophonium (tensilon test)- immediately resolves symptoms (can cause badycardia, asystole, bronchoconstriction, sweating, cramping): have atropine at bedside; ice test, blood test, MRI, EMG Nursing management: >>Stable blood levels is critical- meds should be given on time (dysphasia if not given) >>Eat when meds are at peak (soft foods, upright, supplements) >>Avoid emotional stress, infections, vigorous exercise >>Motinor S/S of myasthenic and cholinergic crisis, provide adequate ventilation, assessment and provide supportive measurements Treatment: >>anticholinesterase drug (pyridostigmine), immunosuppressants (corticosteroids, methotrexate,rituximab) , IVGB, thymectomy and plasmapheriesis

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).

Hemorrhagic Stroke Complications

o Vasospasm (blood vessels constrict and begin to spasm) o Seizures (be aware of seizure precautions like suction, oxygen, turning to left side, not putting anything in mouth, timing the seizure; Ativan) o Hydrocephalus o Rebleeding o Hyponatremia

Multiple Sclerosis (MS)

progressive demyelination of CNS (Relapsing and remitting)- NO CURE Diagnosis: MRI (sees plaques in CNS) and spinal tap (CSF) Assessment test: urodynamics studies (bladder emptying studies) and neuropsychological testing Nursing management >>Prevent injury, visual aids, memory aids, structured environment and daily routine, minimize stress, adequate temp environment, assistance devices, client and fam teaching/coping >>High fall risk (walk with wider foot base), avoid extreme temperatures (nothing hot- burns or cold-spasticity), fatigue is very common and debilitating (treat anemia), consider cognitive changes, screen for suicide (depression). Treatment: >> Immunomodulators/immunosuppressants and steroids can be used to treat symptoms and treat exacerbations.