neurologic

Cauda Equina Syndrome

Cauda equina syndrome results from compression (squeezing) of the cauda equina-the sac of nerves and nerve roots at the base and just below the spinal cord in the lumbosacral spinal canal. It is a rare but serious disorder, and a medical emergency. The nerves of the cauda equina provide motor and sensory function to the legs and the bladder. Compression of these nerves can interrupt their function, and the effects can be severe. Cauda equina syndrome can lead to bladder and bowel dysfunction (loss of bladder/bowel control) and even permanent paralysis in the muscles of one or both legs.

the nurse is providing instructions to a client who is scheduled for a sleep deprivation EEG. which statement by the client demonstrates an understanding of the procedure?

I will not drink any black tea or coffee to calm my nerves before I come to the clinic black tea and coffee are correct because they contain caffeine which will interfere with the results of the sleep deprivation EEG

carotid endarterectomy

In carotid endarterectomy, you receive a local or general anesthetic. Your surgeon makes an incision along the front of your neck, opens your carotid artery and removes the plaques that are clogging your artery. Then, your surgeon repairs the artery with stitches or a patch made with a vein or artificial material (patch graft).

laminectomy

Laminectomy is surgery that creates space by removing the lamina — the back part of a vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves. This pressure is most commonly caused by bony overgrowths within the spinal canal, which can occur in people who have arthritis in their spines. These overgrowths are sometimes referred to as bone spurs, but they're a normal side effect of the aging process in some people.

why I might need a laminectomy

Low back or neck pain can range from mild, dull, and annoying to persistent, severe, and disabling. Pain in the spine can restrict your ability to move and function. Laminectomy may be done to ease pressure on the spinal nerves, treat a disk problem, or remove a tumor from the spine. One common reason for having a laminectomy is a herniated disk in the spine.

Dysarthria

Weakness in the muscles used for speech, which often causes slowed or slurred speech.

Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome (WKS) is a neurological disorder. Wernicke's encephalopathy and Korsakoff's psychosis are the acute and chronic phases, respectively, of the same disease. WKS is caused by a deficiency in the B vitamin thiamine. Thiamine plays a role in metabolizing glucose to produce energy for the brain. An absence of thiamine results in an inadequate supply of energy to the brain, particularly to the hypothalamus, which regulates body temperature, growth, and appetite, and also has a role in emotional response. The hypothalamus also controls pituitary functions, including metabolism and hormones, and mammillary bodies, where neural pathways connect various parts of the brain involved in memory functions. The disease is typically associated with chronic alcoholism, but may be associated with malnutrition or other conditions that cause nutritional deficiencies.

the nurse is completing a health history with a client admitted for Guillain barre syndrome. which information would be consistent with the client's health problem?

a respiratory or gastro-intestinal infection a month ago although the exact etiology of Guillain barre syndrome is unknown many clients report a respiratory or gastrointestinal infection 1 to 4 weeks prior to the onset of the neurological symptoms. manifestations include ascending paralysis potentially causing life threatening complications when affecting the respiratory muscles and autonomic nervous system

a client recovering from a right sided stroke has minimal speech deficits but does not know how to self feed or put on clothing. which manifestation of a stroke is this client demonstrating?

apraxia Apraxia is a neurological disorder characterized by the inability to perform motor movements (body movements). such as self feeding, apply clothing etc

a client with expressive aphasia from a recent cerebral vascular accident (CVA) is being discharged from the hospital. which information should the nurse provide to the gamily regarding communication with the client?

ask questions that require yes or no questions expressive aphasia described the inability to use words while difficulty in understanding and speech comprehension is called receptive aphasia. difficulty in both creating and understanding speech is called global aphasia. * do not try to finish sentences for stroke patient

the nurse is assessing a client in the outpatient clinic and notes bilateral nystagmus. which action should the nurse take?

ask the client to stand still with feet touching and eyes closed nystagmus is repetitive uncontrolled eye movements. nystagmus is indicative of an abnormality in the central nervous system and can be the result of a variety of serious medical conditions including trauma, stroke, increased intracranial pressure, drug and or alcohol use and should be further evaluated. ask the client to stand with the feet touching and the eyes closed is correct because this assessment called the Romberg test evaluates the central nervous system. a positive Romberg test occurs when the client is unable to maintain their balance for 20 seconds with their eyes closed. the client may move their feet open their eyes prior to the completion of the 20 second time limit or sway while standing. findings of ataxia or problems with balance can be a sign of central nervous system dysfunction in the cerebellum

a client with a history of chronic alcohol abuse is experiencing hallucinations, vision changes, and memory loss. which intervention should the nurse implement first?

assess client for gait abnormalities the triad of vision changes/nystagmus, ataxia/gait abnormalities and altered mentation (confusion/hallucinations/memory loss/cofabulations) in a client with chronic alcohol abuse is highly suggestive of wernicke Korsakoff syndrome. wernicke Korsakoff syndrome is a neurological disorder caused by vitamin B1 (thiamine) deficiency. assess the client for hair abnormalities is the priority intervention because the presence of ataxia makes diagnosis of wernicke korsakoff syndrome more likely and aids the nurse in the diagnostic process

a client recovering from pituitary tumor removal has a urine output of 3500 ml over 12 hours with a urine specific gravity of 1.0002 what action should the nurse implement?

assess for lethargy confusion and weakness

which actions has the highest priority when caring for a client recovering from spinal surgery in the post anesthesia care unit?

assessing for leakage of cerebrospinal fluid

the nurse is caring for a client who has just experienced a tonic-clonic seizure. which actions should the nurse perform while caring for this client?

- evaluate for changes in motor status - explain to the client what has occurred - ensure the client has an adequate airway - provide a clean gown and perform skin care (the client will be incontinent of bowel and bladder during the seizure)

the nurse is caring for a client with a head injury sustained during a motor vehicle crash. during the assessment the nurse calls for help and wants the physician notified immediately. what did the nurse assess in this client?

- increased blood pressure with widening pulse pressure - heart rate 50 beats per minute - apneic periods manifestations such as rising systolic blood pressure with widening pulse pressure, and bradycardia are known as Cushing's triad

a 67-year-old male client tells the nurse that he has not been able to sleep throughout the night because his legs are continuously moving. which actions should the nurse implement?

- instruct client to avoid caffeine, nicotine, and alcohol - check lab work for iron deficiencies and vitamin D the feeling that the legs are continuously moving while resting is indicative of restless leg syndrome. restless leg syndrome is a neurological condition in which the individual experiences uncomfortable sensation in the legs when lying down

a client is returned to the care area after having a myelogram. what interventions will the nurse plan for this client?

- maintain the

myelogram

A myelogram is a diagnostic imaging test generally done by a radiologist. It uses a contrast dye and X-rays or computed tomography (CT) to look for problems in the spinal canal. Problems can develop in the spinal cord, nerve roots, and other tissues. This test is also called myelography. the injection of a contrast dye into the spinal canal to better view and assess the nerve roots, spinal cord,

a client recovering from a stroke uses a writing tablet to communicate because even though spoken language is understood the client is unable to articulate. in which cerebral location should the nurse suspect this clients stroke occurred?

frontal lobe

the nurse believes that a client with myasthenia graves receiving pyridostigmine (mestinon) is experiencing symptoms of a cholinergic crisis. what did the nurse observe?

hyper-salivation salivation is a cholinergic effect and may be an early sign of cholinergic crisis in a client taking pyridostigmine (mestinon)

a young adult male client is experimenting a cluster headache. what manifestion will the nurse assess in this client?

intense pain around one eye one manifestation of a cluster headache is intense pain around one eye

osmotic demyelination (central pontine myelinosis)

is a neurologic disorder that develops when sodium levels are corrected too rapidly and osmotic changes cause damage to cell in the brain stem and other areas in the central nervous system. the clients laboratory results indicate that the client's sodium level has improved from 118 to 140 in 8 hours. sodium levels should not be raised more than 10-12 in the first 24 hours to prevent osmotic demyelination. symptoms vary depending on the exact area of the brainstem involved but can include all brainstem functions including the cranial nerves (slurred speech, decreased gag reflex, eye movement abnormalities) change in respiratory functioning change in level of consciousness and motor function (limb weakness and even quadriplegia)

Wernicke-Korsakoff syndrome

is a neurological disorder caused by vitamin B1 (thiamine) deficiency. the triad of symptoms * vision changes/nystagmus (repetitive uncontrolled eye movement) * ataxia/gait abnormalities *altered mentation (confusion/hallucinations/memory loss/confabulations)

a client recovering from a head injury is experiencing memory loss. which part of the brain should the nurse suspect has been damaged?

limbic system the limbic system consists of several neurologic structures including the hippocampus, amygdala, and fornix which play an important role in memory formation

a client is admitted with a closed head injury to the frontal lobe region. what might the nurse most likely assess in this client?

loss of motor movements the frontal lobes of the brain control motor movements and verbal expression. an injury to this brain area could lead to the loss of motor movements in the client

the nurse is concerned about a client recovering from a lumbar laminectomy performed the previous day. what did the nurse assess that is causing concern?

need for new bed linens because the bed is soiled fecal incontinence (loss of control of bowel) is an abnormal finding and might indicate caudal equine syndrome. which this health problem the lower lumbar nerve roots are compressed which can lead to fecal and or unary incontinence, decreased sensation in the perianal and saddle area and weakness in the lower extremities

doll's eyes exam

normals doll's eyes assessment of doll's eyes is used as an assessment of neurological functioning. a normal response is the eyes moving in the opposite direction that the head is moved

the nurse notes that a client with Parkinson disease has lost 10 pounds over the last 2 months. what action is most appropriate at this time?

perform swallowing assessment the nurse should be aware that clients with Parkinson disease frequently develop swallowing difficulties as the disease advances this may severely limit the clients food intake and result in weight loss

the nurse is caring for a female client recently diagnosed with Alzheimer's disease. the client's daughter asks what will happen early in the disease process. which response provides the best explanation?

protein deposits will accumulate on your mother's brain cell and may cause frequent mood swings and forgetfulness

while providing care a client with a lumbar spinal cord injury develops bradycardia. what does the nurse suspect is causing this change in heart rate?

suppression of the cardiac accelerator reflex and vasodilation bradycardia is a manifestation of spinal shock and occurs because the cardiac accelerator reflex is suppressed leading to vasodilation

a client with a benign frontal love glioma is demonstrating personality changes and expressive aphasia. what do these manifestations indicate to the nurse?

the client is experiencing expected manifestations from the tumor since the frontal lobe control personality and speech, personality changes and expressive aphasia are expected manifestations from the tumor

the nurse is caring for a client recovering from a left hemispheric hemorrhagic stroke. which information in the client's medical history may have contributed to the development of this health problem?

treated for atrial fibrillation anti platelet and anti-coagulant drugs used in the treatment of atrial fib may predispose a client to intracebral bleeding and hemorrhagic stroke

the nurse is caring for a client with left upper extremity paralysis following a cerebral vascular accident. to prevent client injury which intervention is most important for the nurse to implement?

use of arm sling when client is sitting upright this prevents shoulder subluxation and shoulder hand syndrome. the effect of gravity on the joint over time combined with weakened joint muscles, can lead to the ball of the shoulder int to be pulled in the inferior direction causing shoulder sublimation or dislocation. shoulder hand syndrome occurs when circulation to the hand is affected by prolonged weakness. it first appears as swelling and paleness of the hand and can result in severe contractors if not properly treated. the use of a sling following paralysis of an upper extremity can prevent these complications

the nurse is teaching a client about amyotrophic lateral sclerosis (als). what symptoms should the nurse include in this teaching?

voice change ALS is a neurological degenerative disease caused by degeneration of the upper and lower motor neurons. clients develop muscle atrophy, fascinations, hyperreflexia and spasticity as well as bulbar disease (drooling, voice changes swallowing difficulties) eventually speech may be lost