Neuro Unit 4 set 9
What would the results be if a pt. underwent a lumbar puncture and it came out positive?
- Elevated protein without elevated WBC's
What are some treatments for GBS?(2) treatment should idealy begin within 2 weeks within symptoms to be effective)
- Immunoglobulin therapy( from a donor given to the patient to stop the antibodies that are damaging the nerves) -Plasmapheresis( machine that flters blood to remove the antibodies from the plasma that are attacking the myelin sheath)
What are some common signs and symptoms associated with Meningitis?
- N/V - Fever - Nuchal rigidity - Seizures - photophobia -Severe headache - purpura (dark purple rash) -
Infants with meningitis may present with these 3 signs?
- Opisthotonus position - high pitched cry - bulging fontanel
What are the 2 parts of the peripheral nervous system?
- Somatic - autonomic
What should the pt. do during a lumbar puncture?
- position lateral recumbent with knees up to abdomen and bend chin to chest
What part of the peripheral nervous system controls Autonomic functions?
-Autonomic
What type of med are people with bells palsy on?
-Corticosteroids (not an emergency, most pts. go to their PHCP for an appointment)
How is GBS diagnosed?
-Electromyography and nerve conduction studies ( assesses for demylenation of nerves by determining muscles ability to respond to nerve stimulation) - Lumbar puncture
What part of the peripheral nervous system controls voluntary functions?
-Somatic
What should the pt. do after a lumbar puncture?
-lie flat - consume fluids to help replace lost CSF
GBS reaches it peak after how long?
2 weeks (then remyelinization occurs) 1-2 years to get back to baseline
A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?
A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self"
Which signs are considered cardinal signs of brain death?
Absence of brainstem reflexes Apnea Coma
The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following?
Approximately 60% to 75% of clients recover completely.
The nurse is 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
A client with a T4 level spinal cord injury (SCI) is complaining of a severe headache. The nurse notes profuse diaphoresis of the client's forehead and scalp. Which of the following does the nurse suspect?
Autonomic dysreflexia
The client has been brought to the emergency department by their caregiver. The caregiver says that she found the client diaphoretic, nauseated, flushed and complaining of a pounding headache when she came on shift. What are these symptoms indicative of?
Autonomic dysreflexia
When caring for a client who is post-intracranial surgery, what is the most important parameter to monitor?
Body temperature
About 40% of GBS cases are caused by what GI bacteria?
Campylobacter jejuni
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?
Diplopia and ptosis
The nurse is preparing the client for an acetylcholinesterase inhibitor test to rule out myasthenia gravis. Which is the priority nursing action?
Ensure atropine is readily available
A client with a spinal cord injury says he has difficulty recognizing the symptoms of urinary tract infection (UTI). Which symptom is an early sign of UTI in a client with a spinal cord injury?(2)
Fever and change in urine clarity
The diagnosis of multiple sclerosis is based on which test?
Magnetic resonance imaging
A patient with a C7 spinal cord fracture informs the nurse, "My head is killing me!" The nurse assesses a blood pressure of 210/140 mm Hg, heart rate of 48 and observes diaphoresis on the face. What is the first action by the nurse?
Place the patient in a sitting position.
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.
The nurse is planning to provide education about prevention in the community YMCA due to the increase in numbers of spinal cord injuries (SCIs). What predominant risk factors does the nurse understand will have to be addressed?
Young age Male gender Substance abuse
What are 2 tests that can be used to assess meningitis?
positive kernigs or brazinski
Many times pts. with GBS recently suffered from what?
some type of illness
A client has been diagnosed with a concussion and is preparing for discharge from the ED. The nurse teaches the family members who will be caring for the client to contact the physician or return to the ED if the client demonstrates reports which complications?(3)
Slurred speech Vomiting Weakness on one side of the body
The nurse has documented a client diagnosed with a head injury as having a Glasgow Coma Scale (GCS) score of 7. This score is generally interpreted as
coma
What should the pt. do before a lumbar puncture?
empty bladder
Autoimmune condition where the immune system attacks the nerves in the body. (peripheral nerves and cranial nerves)
Guillain barre Syndrome
A health care provider asks a nurse to assess a patient being evaluated for aseptic meningitis for a positive Brudzinski sign. Which of the following actions should the nurse take?
Help the patient flex his neck and observe for flexion of the hips and knees.
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?
Multiple sclerosis
What part of the nerve cell is being attacked in GBS?
Myelin sheath
The most common cause of cholinergic crisis includes which of the following?
Overmedication
How does Guillain-Barre syndrome present?
Progressive, *ascending*, relatively symmetric motor weakness w/ mild sensory, sometimes CN involvement
A client has a spinal cord injury. The home health nurse is making an initial visit to the client at home and plans on reinforcing teaching on autonomic dysreflexia. What symptom would the nurse stress to the client and his family?
Sweating