Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies- ch. 64

Brain abscess signs and symptoms

Headache usually worse in the morning, fever, vomiting, neuro deficits, increased ICP. -Ceftriaxone with metronidazole which can be adjusted based on c&s. Also, corticosteroids and anticonvulsants.

Meningitis signs and symptoms

Headache, fever, changes in LOC, behavioral changes, nuchal rigidity, positive Kernig's sign, positive Brudzinski sign, and photophobia.

Herpes Simplex Encephalitis signs and symptoms

Headache, fever, confusion, hallucinations; vector borne-rash, flaccid paralysis, Parkinson-like movements.

Difficulty in coordination

A middle-aged client has sought care for the primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the client to seek care?

Cerebellar abscess

-Ataxia -Nystagmus -Occipital headaches

Temporal Lobe abscess

-Changes in vision -Facial weakness -Localized headache -Receptive aphasia

Frontal Lobe abscess

-Expressive aphasia -Frontal headache -Hemiparesis -Seizures

Creutzfeldt-Jakob disease (CJD)

-Get it by eating beef -No cute -FATAL -Severe cognitive impairment

GBS

-Support limbs in functional position. -Passive ROM at least twice a day. -Change positions Q2H. -Compression hose or SCDs. -Adequate hydration. -IV and parenteral nutrition. -Assess swallowing/gag reflex. -Decreasing fear and anxiety.

Blurred vision, intention tremor, and urinary hesitancy

A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS?

The client needs to be assessed for MS

A 48-year-old client had been diagnosed with trigeminal neuralgia following recent episodes of unilateral face pain. The nurse should recognize what implication of this diagnosis?

-Administer antipyretics as prescribed -Perform frequent neurologic assessments -Monitor pain levels and administer analgesics

A 69-year-old client is brought to the ED by ambulance because a family member found the client lying on the floor disoriented and lethargic. The health care provider suspects bacterial meningitis and admits the client to the ICU. What interventions should the nurse perform? Select all that apply.

Many symptoms can be the result of normal aging process

A 73-year-old client comes to the clinic reporting weakness and loss of sensation on the feet and legs. Assessment is the client shows decreased reflexes bilaterally. Why would it be a challenge to diagnose a peripheral neuropathy in the client?

Whistling

A client diagnosed with Bell's palsy is having decreased sensitivity to touch of the involved nerve. What should the nurse recommend to prevent atrophy of the muscles?

Decreased muscle spasms in the lower extremities

A client diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is Baclofen. What should the nurse identify as an expected outcome of this treatment?

Symptom improvement that lasts a few weeks after TPE ceases

A client diagnosed with myasthenia gravis has been hospitalized to receive therapeutic plasma exchange (TPE) for a myasthenic exacerbation. The nurse should anticipate what therapeutic response?

Close monitoring of fluid balance

A client is admitted through the ED with suspected St. Louis encephalitis. The unique clinical feature of St. Louis encephalitis will make what nursing action a priority?

Dimming the lights and reducing stimulation

A client is being admitted to the neurologic ICU with suspected herpes simplex virus encephalitis. What nursing action best addresses the client's reported headache?

Peripheral nerve disorder

A client presents at the clinic with pain and weakness in the hands. On assessment, the nurse notes diminished reflexes in the upper extremities bilaterally and bilateral loss of sensation. The nurse knows that these findings are indicative of what condition?

Positive Kernig sign

A client presents to the clinic reporting a headache. The nurse notes that the client is guarding the neck and tells the nurse about stiffness in the neck area. The nurse suspects the client may have meningitis. What is another well-recognized sign of this infection?

Prepare to assist with intubation

A client with Guillain-Barré syndrome has experienced a sharp decline in viral capacity. What is the nurse's most appropriate action?

Position the client upright during feeding

A client with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform?

Protection of the affected limb from injury

A client with diabetes presents to the clinic and is diagnosed with a mononeuropathy. This client's nursing care should involve which of the following?

Acyclovir

A client with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the health care provider to order for the treatment of this disease process?

The client should be monitored for bone marrow depression

A client with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine for pain relief. What principle applies to the administration of this medication?

Neck flexion produces flexion of knees and hips

A client with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a client with this disgnosis?

EEG

A client with suspected Creutzfeldt-Jakob disease (CJD) is being admitted to the unit. The nurse would expect what diagnostic test to be ordered for this client?

In the morning, with frequent rest periods

A nurse is planning the care of a 28-year-old client hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client?

Applying a protective eye shield at night

A patient diagnosed with Bell's palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions?

Multiple Sclerosis

A progressive immune-related demyelination disease of the CNS. -Fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain, and visual disturbance. -Affects women more than men. -Disease modifying therapies; Interferon B 1a and 1b, glatiramer acetate, and IV methylprednisolone for 3-5 days. Mitoxantrone is given IV every 3 months.

Herpes Simplex Encephalitis

EEG and CSF exam. -Acyclovir and an antiviral agent improves prognosis. Treatment should continue for up to 3 weeks. Slow admin over 1 hr prevents crystallization of the medication in the urine.

Bell's Palsy

Facial paralysis caused by unilateral inflammation of the 7th cranial nerve. -s/s: unilateral facial muscle weakness or paralysis with facial distortion, increased lacrimation, and painful sensations in the face. May have difficulty with speech and eating. -Most patients recover completely in 3-5 weeks. -Corticosteroids and protect eye from injury, cover eye with shield at night.

Myasthenia Gravis

Autoimmune disorder affecting the myoneural junction. -s/s: involve ocular muscles, diplopia and ptosis. Weakness of facial muscles, swallowing, voice impairment, generalized weakness.

Guillain-Barre Syndrome

Autoimmune disorder with acute attack of peripheral nerve myelin. -s/s: May include weakness, paralysis, paresthesias, pain, and diminished or absent reflexes, starting either lower extremities and progressing upward. Tachycardia, bradycardia, HTN or hypotension. -MEDICAL EMERGENCY! -Plasmapheresis and IVIG. -monitor/assess for Respiratory failure, cardiac dysrhythmias, and DVT. -assess VS and ECG

Trigeminal neuralgia treatment

Carbamazepine, gabapentin, phenytoin, or antispasmodic medication (Baclofen). -sx: micro vascular decompression of trigeminal nerve. Radio frequency thermal coagulation, percutaneous balloon microcompression. -Avoid triggers, soft food, chew on unaffected side, avoid hot/cold food.

Trigeminal Neuralgia (Tic Douloureux)

Condition of the 5th cranial nerve characterized by paroxysms of pain. -Familial: vascular compression and pressure is probable cause. -Pain can occur with any stimulation such as washing face, brushing teeth, eating, or draft of air. -May avoid eating, neglect hygiene, and isolate themselves.

Peripheral neuropathies

Disorder affecting the peripheral motor and sensory nerves. -Inspect skin for breakdown. -Assistive devices such as walker or can to decrease falls. -Bathwater temperature should be checked. -Footwear should be accurately sized.

Dexamethasone

Help with inflammation- give before or concurrently with the first dose of ABX and every 6 hours for the next 4 days.

Ataxia

Impaired coordination of movement during voluntary movement.

Medical management of meningitis

Penicillin G in combo with one of the cephalosporins is often administered IV- bacterial meningitis.

Taking care of pts with MS

Preventing falls, managing fatigue. Strengthening coping mechanisms, promoting physical mobility.

Medical management of Myasthenia Gravis

Pyridostigmine bromide, and anti-cholinesterase medication of the 1st line therapy. HAS TO BE GIVEN ON TIME! IVIG, thymectomy, therapeutic plasma exchange.

Diplopia

The awareness of two images of the same object occurring in one or both eyes (double vision).

Increased muscle strength

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begin treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication?

Providing ventilatory assistance

The critical care head is admitting a client in myasthenic crisis to the ICU. The nurse should prioritize what nursing action in the immediate care of this client?

Monitoring neurologic status closely

The critical care nurse is caring for 25-year-old man admitted to the ICU with a brain abscess. What is a priority nursing responsibility in the care of this client?

Autonomic dysfunction

The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for what potential complication?

-Possible nursing home placement -Increasing disability -Becoming a burden on the family

The nurse is caring for a 77-year-old woman with MS. The client is very concerned about the progress of the disease and what the future holds. The nurse should know that older adult clients with MS are known to be particularly concerned about what variables? Select all that apply.

Resting in an air-conditioned room whenever possible

The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest?

Instruct the client on daily muscle stretching

The nurse is creating a plan of care for a client who has a recent diagnosis of MS. Which of the following should the nurse include in the client's care plan?

Facial paralysis

The nurse is developing a plan of care for a client newly diagnosed with Bell's Palsy. The nurse's plan of care should address what characteristic manifestation of this disease?

Using the incentive spirometer as prescribed

The nurse is developing a plan of care for a client with Guillain-Barré syndrome. Which of the following intervention should the nurse prioritize for this client?

Avoid running the eye on the affected side of the face

The nurse is discharging a client home after surgery for trigeminal neuralgia. What advice should the nurse provide to this client in order to reduce the risk of injury?

Washing the face

The nurse is planning discharge education for a client with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. What would the nurse be correct in teaching the client to avoid?

A lower motor neuron lesion

The nurse is preparing to provide care for a client diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result is what issue?

"Guillain-Barre spares the Schwann cell, which allows for remyelination in the recovery phase of the disease."

The nurse is teaching a client with Guillain-Barré syndrome about the disease. The client asks how the client can ever recover if demyelination of the nerves is occurring. What would be the nurse's best response?

MS is a progressive demyelinating disease of the nervous system

The nurse is working with a patient who is newly diagnosed with MS. What basic information should the nurse provide to the client?

Vocal paralysis

The nurse planning caring for a client diagnosed with Guillain-Barré syndrome. The nurse's communication with the client should reflect the possibility of which sign is symptom of the disease?

Blood levels of the drug must be monitored

To alleviate pain associated with trigeminal neuralgia, a patient is taking carbamazepine. What health education should the nurse provide to the client before initiating this treatment?

Fluid volume expanders

Treatment of dehydration, shock, and seizure.

Dysphonia

Voice impairment or altered voice production

Prion

a pathogen smaller than a virus that is resistant to standard sterilization procedures

Myasthenic Crisis vs. Cholinergic Crisis

myasthenic crisis: exacerbation of myasthenic symptoms caused by NOT enough cholinesterase inhibitors. Absence of cough and swallow reflex. Tensilon test is performed. Caused by infection. Priority: Adequate Respiratory function. Cholinesterase drugs withheld because they increase respiratory secretions, usually ineffective the first few days after crisis begins. Cholinergic crisis: Parasympathetic effect, decreased HR, B/P, decreased airways. Acute exacerbation of muscle weakness, caused by overmedication with cholinesterase inhibitors. Atropine give to dry up secretions. Could end up on ventilator for a day/two.

Paresthesia

numbness, tingling, or a "pins and needles" sensational