Neurological

Geriatric/Gerontological Considerations Neurological Changes

1. Slowed body movements 2. Decreased reaction time 3. Decreased muscle strength and flexibility 4. Decreased sense of touch, smell, temperature, and pain sensations 5. Possible cognitive impairment, such as confusion and/or memory loss—care must be taken to carefully evaluate for other causes of cognitive issues, such as infection.

The nurse correlates which responses as associated with the sympathetic nervous system? (Select all that apply.) A. Increased heart rate B. Decreased respiratory rate C. Increase in peristalsis D. Dilated bronchioles E. Decreased heart rate

A & D Rationale: The sympathetic nervous system increases respiratory rate (dilates bronchi) and HR. It inhibits peristalsis of the GI tract and dilates pupils. The parasympathetic nervous system causes decreased heart rate and respiratory rate, increases peristalsis of the GI tract, and constricts pupils.

A nurse is performing the initial interview of a patient presenting to the clinic because of neurological complaints. Which actions by the nurse are appropriate? (Select all that apply.) A. Assessment of physical appearance B. Comprehensive medication list review C. Reassurance that all will be okay D. Review of alcohol and drug use E. Review of risks

A, B, and D Rationale: The nurse should not provide potentially false reassurance all will be okay or use this opportu- nity to teach regarding the dangers of alcohol use.

The nurse correlates which clinical manifestations with age-related changes of the nervous system? (Select all that apply.) A. Decreased visual acuity B. Increased pain sensation C. Balance problems D. Dementia E. Decreased pain sensation

A, C, and E Rationale: Changes in the aged patient include decreased vision, balance and gait problems, and decreased pain sensation. Dementia should not be considered a normal part of aging—other causes should be ruled out.

The nurse recognizes that patients with major changes in personality most likely have damage in which lobe of the brain? A. Frontal B. Occipital C. Parietal D. Temporal

A: Frontal Rationale: The frontal lobe is responsible for voluntary motor movement, Broca's speech, personality, and behavior. The occipital lobe is primarily responsible for vision. The parietal lobe is responsible for sensory input and integration and spatial relationships. The temporal lobe is responsible for auditory sensation and perception, memory, and Wernicke's speech center.

Abnormalities of the Motor System

• Atrophy: decrease in muscle mass • Paresis: slight or incomplete paralysis • Plegia: complete loss of muscle function • Contraction: shortening or tightening of the muscles • Involuntary movements: uncontrolled movements • Spasm: involuntary muscle contraction • Spasticity: increased muscle tone that creates stiff movement

A patient is scheduled for an emergency CT scan because of clinical manifestations of a CVA/stroke. The nurse recognizes which statement as true about the findings of the CT scan? A. Thrombolytics are contraindicated if the scan identifies a bleed. B. Thrombolytics are indicated if the scan is positive for a bleed. C. Thrombolytics are contraindicated if the scan identifies an occlusion. D. Thrombolytics are indicated if the scan identifies an occlusion.

A Rationale: Thrombolytics are clot busters. If the patient has had a hemorrhagic stroke, thombolytics will cause additional bleeding. If the scan is negative for a bleed, the patient may receive a thromolytic to dissolve the clot if there are no other contraindications such as use of anticoagulants.

Abnormalities of the Sensation of Pain

Analgesia Complete lack of pain sensation Hypalgesia or Hypoalgesia Decreased ability to feel the pain sensation Hyperalgesia Hypersensitivity to a painful stimulus

Abnormalities of the Sensory System

Anesthesia Absence of sensation; sensations are blocked Hypoesthesia Decreased sense of touch or sensation; numbness Hyperesthesia Increased sensitivity to touch Paresthesia Abnormal feeling of pins and needles; itching, numbness, and tingling

Which question by the patient having cerebral angiography indicates that teaching has been effective? A. "This is a fairly simple x-ray test, right?" B. "Is it unusual if I get hot and flushed when you inject the dye?" C. "My kidneys have to be in good shape to get this dye, right?" D. "Is this test to see if an infection is causing my problem?"

C Rationale: Contrast dye used in angiography is nephro- toxic. Angiography is not simple and is not done to rule out infection. A hot flushed feeling is a common when dye is injected.

Abnormal Respiratory Patterns

Cheyne-Stokes respiration An increase in rate followed by short periods of apnea Metabolic disorder; bilateral cerebral or cerebellar lesions Central neurogenic hyperventilation Deep, rapid breathing; increase in rate and depth; greater than 25 per minute (can be 40-70 per minute) Midbrain and upper pons disorder Apneustic breathing Slow, deep breathing, then a pause; breath held and released Disorder of midbrain to lower pons Cluster breathing; Biot's Irregular breathing with periods of apnea Lower pons or upper medulla disorder Ataxic respiration Irregular rate and depth with irregular periods of apnea Upper medulla disorder Kussmaul's breathing Rapid and shallow, then deep and labored Severe metabolic acidosis; diabetic ketoacidosis; renal failure