Med Surg Chapter 69

The nurse caring for a patient with bacterial meningitis is administering dexamethasone (decahedron) that has been ordered as an adjunct to antibiotic therapy. When does the nurse know is the appropriate time to administer this medication?

15 to 20 minutes before the first dose of antibiotics and every 6 hours for the next 4 days

The nurse is assisting with administering a Tensilon test to patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur?

30 seconds after the the administration the facial weakness and ptosis will be relieved for approximately 5 minutes

Guillain Barre Syndrom (GBS) CN

CN 10

Vagal body tumors CN

CN 10

Optic Neuritis cN

CN 2

Pituitary tumor CN

CN 2

Sinus tract tumor CN

CN 5

Trigeminal Neuralgia CN

CN 5

The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What's subjective data stated by the patient does the nurse determine triggered the paroxysms of pain?

I was brushing my teeth

The nurses caring for a patient admitted to the hospital with a brain abscess that developed from an untreated case of otitis media. What assessment data is a priority to alert the nurse to changes in intracranial pressure?

Level of consciousness

A patient diagnosed with MS two years ago has been admitted to the hospital with another relapse. The previous relapse followed a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has?

Relapsing-remitting (RR)

A patient has been diagnosed with meningococcal meningitis at a community living home. When should the prophylactic therapy begin for those who have had close contact with the patient?

Within 24 hours of exposure

Myasthenia Gravis is considered an autoimmune disease in which antibodies are directed against

acetylcholine receptors

The majority of patients with Myasthenia Gravis exhibit these two clinical signs __________

double vision, ptosis

The three diagnostic tests use to support diagnosis of Creutzfeldt- Jakob are ___________

immunologic assessment, EEG, MRI

The nurse is volunteering for Red Cross blood drive and is taking the history of potential donors. Which volunteer will the nurse know will not be allowed to donate blood?

A donor who was in college in England for 1 year

A patient suspected of having GBS has had a lumbar puncture for cerebrospinal fluid evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease?

Elevated protein levels in the CSF

A patient with Bell's palsy says to the nurse "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient?

Suggest massaging the face several times daily, using a gentle upward motion to maintain muscle tone

_____________ with _______ is the clinical feature unique to the patient with St. Louis encephalitis.

Syndrome of inappropriate antidiuretic hormone (SIADH) with hyponatremia

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (mestinon) on time. The nurse gets busy and does not administer the medication until breakfast. What outcome will the patient have related to this late dose?

The muscles will become fatigue and the patient will not be able to chew food or swallow pills

The primary pathology of MS is damage of the

myelin sheath

Meniere's Syndrome CN

CN 8

______ and _________ are the bacteria responsible for the majority of cases of bacterial meningitis in adults.

Streptococcus pneumoniae, Neisseria meningitides

The nurse is using a beds risk scoring system for an adult patient with bacterial meningitis. Name 5 risks for an unfavorable outcome:

older age, a HR of 120 of higher, decreased score of the Glasgow Coma Scale, cranial nerve palsies, positive Gram stain 1 hour after presentation to the hospital

Classic clinical features of Guillain- Barre syndrome (GBS) are ______ and _______.

areflexia, ascending weakness

The nurses caring for a patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What interventions should be provided in order to determine the presence of autonomic dysfunction?

Assess the blood pressure and heart rate

What strategies can the nurse educate the patient with MS about to avoid the disabling effects of fatigue?

Avoiding hot temperatures, effective treatment of depression and anemia, occupation and physical therapy to help control fatigue, a balance of rest and activities, good nutrition, avoid obesity, avoidance of alcohol and tobacco.

In nurses caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. What interventions can the nurse provide to assist with relieving the spasms? (select all that apply)

Demonstrate daily muscle stretching exercises, apply warm compresses to the affected area, allow the patient adequate time to perform exercises

The nurse is administering the IV antiviral medication ganciclovir (cytosine) to a patient with the HSV1 encephalitis. What is the best way for the nurse to administer the medication to avoid crystallization of the medication in the urine?

Administered via slow IV over 1 hour

A college student goes to the infirmary with a fever, headache, and a stiff neck. The nurse suspects the student may have meningitis and has the student transferred to the hospital. If the diagnosis is confirmed, what should the nurse institute for those who have been in contact with the student? (Select all that apply)

Administration of Rifampin, Cipro, Rocephin

Herpes Zoster CN

CN 7

Disease modifying therapies that are available to treat MS include ________ therapies and _________agents

immunomodulating, immunosuppressive

During a Tensilon test to determine if the patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42 and respiration 18. What intervention should the nurse prepare to do?

Administer atropine to control the side effects of edrophonium.

The most common cause of acute encephalitis in the United States is __________. The two medications of choice for this disorder are _______ and _________.

herpes simplex virus (HSV) acyclovir (Zovirax), ganciclovir (Cytosine)

Brain stem ischemia CN

CN 6

Bells palsy CN

CN 7

The infectious disorders of the nervous system are

meningitis, brain abscesses, various types of encephalitis, CJD

Explain what demyelination refers to in reference to MS

the destruction of myelin, the fatty and protein material that surrounds nerve fibers in the brain and spinal cord. The destruction results in impaired transmission of nerve impulses.