Chapter 65: Management of Patients with Oncologic or Degenerative Neurologic Disorders

Paresthesia

A sensation of pins and needles

The nurse is caring for a patient with Huntington disease in the long-term care facility. Which most prominent symptom that correlates with this disease will the nurse document? A) Rapid, jerky, involuntary movements B) Slow, shuffling gait C) Dysphagia and dysphonia D) Dementia

A) Rapid, jerky, involuntary movements

A patient with Huntington disease is prescribed medication to reduce the chorea. Which medication will the nurse administer that is the only drug approved for the treatment of this symptom? A) Tetrabenazine B) Carbamazepine C) Phenobarbital D) Diazepam

A) Tetrabenazine

Dysphonia

Abnormal voice quality caused by incoordination of speech muscles

Charles Grimes is a 76 year old retired professional golfer recently diagnosed with Parkinson's disease. He has tremors visible in both hands and stated that he noticed he is walking with a shuffling gait and that his friend has been telling him to "pick up your feet when you're walking". Mr. Grimes will be started on a chemotherapy program using carbidopa/levodopa. What is the explanation of adding carbidopa to levodopa?

Added to avoid metabolism of levodopa before it can reach the brain

A patient with Parkinson's disease is exhibiting bradykinesia, rigidity, and tremors. These symptoms are directly related to which decreased neurotransmitter level? A) Acetylcholine B) Dopamine C) Serotonin D) Phenylalanine

B) Dopamine

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse assesses that the patient's voice has changed since the last visit and is now more difficult to understand. How will the nurse document this finding? A) Dysphagia B) Dysphonia C) Hypokinesia D) Micrographia

B) Dysphonia

The nurse is preparing to administer medications to a patient with Parkinson's disease. Which medication is administered that is considered the most effective drug currently given for the tremor of Parkinson's? A) Ropinirole B) Levodopa C) Amantadine D) Pergolide mesylate

B) Levodopa

A patient with ALS asks if the nurse has heard of a drug that will prolong the patient's life. Which is the best response to the patient's inquiry that may prolong life by 3 to 6 months? A) Baclofen B) Riluzole C) Dantrolene sodium D) Diazepam

B) Riluzole

The adult child of a patient with Huntington disease asks the nurse what the risk is of inheriting the disease. Which is the best response by the nurse? A) "The disease is not hereditary and therefore, there is no risk to you." B) "If one parent has the disorder, there is a 75% chance that you will inherit the disease." C) "If one parent has the disorder, there is a 50% chance that you will inherit the disease." D) "The disease is inherited and all offspring of a parent will develop the disease."

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

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. Which intervention will the nurse include when developing the plan of care to assist with a regular stool pattern? A) Take psyllium daily B) Take a laxative whenever bloating is experienced C) Adopt a diet with moderate fiber intake D) Adopt a high fiber diet

C) Adopt a diet with moderate fiber intake

A patient is diagnosed with ALS. The nurse understands that the symptoms of the disease will begin in what way? A) Ascending paralysis B) Numbness and tingling in the lower extremities C) Weakness starting in the muscles supplied by the cranial nerves D) Jerky, uncontrolled movements in the extremities

C) Weakness starting in the muscles supplied by the cranial nerves

Mike Carrol is a 49 year old TV producer who has been diagnosed as having Huntington disease. He lives alone in a penthouse apartment and is extremely busy and successful in his business. He has no living relatives. He is experiencing uncontrollable movements and has difficulty feeding himself. He recently started chemotherapy with haloperidol. What does the nurse recognize as the most prominent features that he has related to the diagnosis of Huntington disease?

Chorea - rapid, jerky, purposeless movements Impaired voluntary movements Intellectual decline Personality changes

A patient with Parkinson's disease is experiencing an on-off syndrome. Which assessment of the patient's clinical symptoms correlates with this syndrome? A) Unilateral resting tremors and then a period of no tremors present B) Slow, shuffling gait and then able to move at faster gait C) A period when medication with levodopa will be unnecessary D) Periods of near immobility, followed by a sudden return of effectiveness of the medication

D) Periods of near immobility, followed by a sudden return of effectiveness of the medication

Charles Grimes is a 76 year old retired professional golfer recently diagnosed with Parkinson's disease. He has tremors visible in both hands and stated that he noticed he is walking with a shuffling gait and that his friend has been telling him to "pick up your feet when you're walking". Why is it important for the nurse to ensure that Mr. Grimes be started on an exercise regimen as part of his treatment plan?

Daily exercise will increase muscle strength, improve coordination and dexterity, reduce muscular rigidity, and prevent contractures that occur when muscles aren't used

The 5 chief symptoms of ALS are:

Fatigue Cramps Progressive muscle weakness Twitching Incoordination

Dyskinesia

Impaired ability to execute voluntary movement

Charles Grimes is a 76 year old retired professional golfer recently diagnosed with Parkinson's disease. He has tremors visible in both hands and stated that he noticed he is walking with a shuffling gait and that his friend has been telling him to "pick up your feet when you're walking". The nurse is developing a plan of care for Mr. Grimes. Which goals does the nurse set for him?

Improving functional mobility Maintaining independence in ADLs Achieving adequate bowel elimination Maintaining adequate nutrition

Chorea

Rapid, jerky, purposeless movements of extremities or facial muscles

Akathisia

Restlessness and agitation

Mike Carrol is a 49 year old TV producer who has been diagnosed as having Huntington disease. He lives alone in a penthouse apartment and is extremely busy and successful in his business. He has no living relatives. He is experiencing uncontrollable movements and has difficulty feeding himself. He recently started chemotherapy with haloperidol. Mr. Carrol has been prescribed a selective serotonin reuptake inhibitor (SSRI) included with other medications. What benefit will the SSRI have for him during his disease?

SSRI and tricyclic antidepressants control psychiatric symptoms. The threat of suicide is present particularly early in the course of the disease. Psychotic symptoms usually respond to antipsychotic meds

When a patient is assessed and determined to have Parkinson's disease, which clinical manifestation is most commonly present?

Slow, unilateral resting tremor is present in the majority of patients at the time of diagnosis

Mike Carrol is a 49 year old TV producer who has been diagnosed as having Huntington disease. He lives alone in a penthouse apartment and is extremely busy and successful in his business. He has no living relatives. He is experiencing uncontrollable movements and has difficulty feeding himself. He recently started chemotherapy with haloperidol. Mr. Carrol has informed the nurse that he has no relatives or close friends who would be able to assist with his care. Which information will the nurse provide about the resources available to assist with his care?

The Huntington's Disease Society of America helps patients and family by providing information, referrals, family and public education, and support for research

The 4 cardinal signs of Parkinson's disease are:

Tremor Rigidity Bradykinesia Postural instability

Bradykinesia

Very slow voluntary movements and speech

Charles Grimes is a 76 year old retired professional golfer recently diagnosed with Parkinson's disease. He has tremors visible in both hands and stated that he noticed he is walking with a shuffling gait and that his friend has been telling him to "pick up your feet when you're walking". Which types of exercise might the nurse recommend and why?

Walking, riding stationary bike, swimming, gardening, ROM exercises, and stretching