Neurosensory Module
Describe a cluster headache.
o Severeand unrelenting pain o Cluster comes from various places of involvement o Severe unrelenting unilateral pain in and around the eyes o Trigeminal cluster headache is common which involves the mouth and ears
A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication? A) Lateral rotation of head and neck B) Clear yellowish drainage on the dressing C) Use of the standing position to void D) Non-productive cough
B
A nurse is assessing a client who reports severe headache and a stiff neck. The nurse's assessment reveals positive Kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first? a. Administer antibiotics b. Implement droplet precautions c. Initiate IV access d. Decrease bright lights
B
A nurse is caring for a client who has AD and falls frequently. Which of the following actions should the nurse take first to keep the client safe? A. Keep the call light near the client B. Place the client in a room close to the nurses' station C. Encourage the client to ask for assistance D. Remind the client to walk with someone for support
B
Describe a tension headache.
Can be chronic or episodic Chronic headaches occur more than 15 days a month over a 3-6 months time span -Chronic are more severe than episodic headaches Episodic headaches occur about 10 to 15 days per month and lasts about 30 minutes Pressure in one spot of the head Stress headache due to concentrating
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? Select all that apply. a. Avoid overwhelming fatigue b. Remove caffeinated products from the diet c. Limit looking at flashing lights d. Perform aerobic exercise e. Limit episodes of hypoventilation Use of aerosol hairspray is recommended
A, B, C
Treatment of Parkinson's disease?
o Only focuses on the symptoms, there is no cure o Increased dopamine or decrease acetylcholine
What are 8 diagnostic tests for neurosensory issues?
1. computerized tomography (CT) 2. positron emission tomography (PET) 3. magnetic resonance imaging (MRI) 4. magnetic resonance angiography (MRA) 5. cerebral angiography 6. electroencephalography (EEG) 7. lumbar puncture (LP) 8. pyelogram
What are the 3 types of headaches?
1. tension 2. cluster 3. migraine
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? a. Keep the client in a side-lying position b. Document the duration of the seizure c. Reorient the client to the environment d. Provide client hygiene
A
A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include? a. Rise slowly when standing b. Expect urine to become dark-colored c. Avoid foods containing tyramine d. Report any skin discoloration
A
What is Brudenski's sign?
o Passive flexion of neck causes flexion of both legs and thighs. o Favored over the other.
A nurse is assessing a client who has a seizure disorder. The client tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse implement? Select all that apply. a. Provide privacy b. Ease the client to the floor if standing c. Move furniture away from the client d. Loosen the client's clothing e. Protect the client's head with padding f. Restrain the client
A, B, C, D, E
A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following actions should the nurse take when performing this technique? Select all that apply. a. Place client in supine position b. Flex client's hip and knee c. Place hands behind the client's neck d. Bend client's head toward chest e. Straighten the client's flexed leg at the knee
A, C, D
A nurse is making a home visit to a client who has AD. The client's partner states that the client is often disoriented to time and place, is unsteady on his feet, and has a history of wandering. Which of the following safety measures should the nurse review with the partner? (Select all that apply) A. Remove floor rugs B. Have door locks that can be easily opened C. Provide increased lighting in stairwells D. Install handrails in the bathroom E. Place the mattress on the floor
A, C, D, E
A nurse is caring for a client who is having surgery for the removal of an encapsulated acoustic tumor. Which of the following potential complications should the nurse monitor for postoperatively? (Select all that apply) A. Increased intracranial pressure B. Hemorrhagic shock C. Hydrocephalus D. Hypoglycemia E. Seizures
A, C, E
A nurse is caring for a client who has AD. A family member of the client asks the nurse about risk factors for the disease. Which of the following should be included in the nurse's response? (Select all that apply) A. Exposure to metal waste products B. Long-term estrogen therapy C. Sustained use of vitamin E D. Previous head injury E. History of herpes infection
A, D, E
Cranial nerve 6
Abducens
The RN is caring for a client with Parkinson's disease who is experiencing a freezing gait with difficulty initiating movement. Which of the following recommendations by the RN would be most helpful for this client? a. Gently pull the client forward to get them started b. Tell the client to march in place c. Let them use their wheelchair today d. Have them remain still and take deep breaths for 5 minutes
B
A nurse is planning care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? Select all that apply. a. Monitor for bradycardia b. Provide an emesis basin at the bedside c. Administer antipyretic medication d. Perform a skin assessment e. Keep the head of the bed flat
B, C, D
A nurse is assessing a client for manifestations of Parkinson's disease. Which of the following are expected findings? Select all that apply. a. Decreased vision b. Pill-rolling tremor of the fingers c. Shuffling gait d. Drooling e. Bilateral ankle edema f. Lack of facial expression
B, C, D, F
Nursing care for low back pain?
COLDSPA
Management of primary brain tumors?
Chemotherapy and radiation -There are very few types of chemotherapy that only targets the brain because chemotherapy is systemic -Radiation shrinks the tumor down to an operable size but the patient has to go every day for 6 weeks -Chemotherapy or the drug has to be able to cross the blood-brain barrier in order for it to work Biopsies of the tumor Craniotomy -Section of the skull is removed - called a bone flap is created to create access to the brain (can be inserted in the abdomen or can be frozen) -The biggest thing is how they do it and how they prep this patient -The patient is normally awake for this procedure -The neuro assessment prior to the craniotomy is important -Immediately before the surgery, the patient is going to have a full neurological assessment because we want to know their baseline prior to surgery
Post-operative care for herniated disc?
o Patient is generally discharged the next day o Bleeding, site assessment o Vital signs o Pain assessment o Make sure patient can perform ADLs o Bowel and bladder function o Fluid intake o Increased fiber due to opioids so a stool softener may be necessary o Avoid bending at the waist and don't twist o Exercise and stretching
Early signs of Parkinson's disease?
o Pill rolling of the hands o Tremors
A nurse working in a long-term care facility is planning care for a client in stage 4 of Alzheimer's disease. Which of the following interventions should be included in the plan of care? A. Use a gait belt for ambulation B. Thicken all liquids C. Provide protective undergarments D. Assist with ADLs
D
Cranial nerve 7
Facial
Risk factors for multiple sclerosis?
Females between the ages of 20-30
Cranial nerve 12
Hypoglossal
Describe multiple sclerosis exacerbations.
Infections account for 1/3 of multiple sclerosis exacerbations Encourage patient to get the flu vaccination
What is meningitis?
Inflammation in the meninges which are located in the lining of the brain Can be bacterial or viral and bacterial is worseand it is most lethal - viral will go away o Bacterial meningitis vaccine is recommended o Streptococcus pneumonae o Neisseria meningitis
What is amyotrophic lateral sclerosis (ALS)?
Lou Gehrig's disease Gradual degeneration and death of motor neurons that progresses rapidly Usually happens after the age of 50 Muscles gradually atrophy and weaken Fatal disease that leads to the inability to move while cognition is still intact -Most people die within 3 to 5 years within the onset of this disease (this is long, it is typically shorter)
Treatment of a migraine?
Medicated with the class called Triptans which knocks you out and then you sleep off the migraine and you are fine when you wake up -"You must be trippin' if you think Tylenol will help your headache" The biggest misconception is taking opioids will help treat a migraine because these can actually induce a migraine
Management of herniated disc?
Medications: NSAIDS, muscle relaxers, sedatives, benzodiazepine Start with conservative treatment -Always first line -Physical therapy Surgical management -Only 10% require surgery -Spinal fusion which joins 2 bones -Lumbar fusion is the gold standard
Medical management for low back pain?
NSAIDS, opioids, muscle relaxers, steroids, physical therapy
Describe a seizure.
Nurses should immediately 1) protect the airway and put oxygen on your patient, 2) call for help and let someone know that you need help, and 3) recovery position (left side to prevent aspiration), have suction available Protect from injury by moving furniture or hold the patient's head in your lap or on the floor but not restraining them NO padded tongue blades Always document onset, duration, and other pertinent information such as bowel and bladder function, consciousness
Cranial nerve 3
Oculomotor
Clinical manifestations of primary brain tumors?
Patient presents with headache, forgetfulness, sensory changes, mood changes (tends to be anger), personality changes Patient will present with some type of neurological signs and symptoms Brain tumors are slow progressing as far as the symptoms As they grow and start to take up room in the brain, serious complications can result such as: Increased intracranial pressure -Headaches -Pressure -Visual disturbances Unexplained seizures -Vomiting Ataxia can also occur which is unbalanced gait Dependent upon their location in the brain Malignant brain tumors are associated with swelling as the rapid growth of the tumor damages the brain tissue
What is Kernig's sign?
Patient supine, with hip flexed 90 degrees. Knee cannot be fully extended.
Cranial nerve 11
Spinal Accessory
What is the most common type of seizure in children?
The most common type of seizure, especially in children is the focal seizures where they just stare into space or on a specific object
Cranial nerve 5
Trigeminal
Cranial nerve 4
Trochlear
Cranial nerve 10
Vagus
Describe electroencephalography (EEG).
o Places electrodes on the skull to check for seizure activity, hypoactivity of the brain, or no activity for the brain o Scalp electrodes - 8 to 24 of them o Determines any abnormalities in the brain waves o Instruct the patient to wash their hair prior to the procedure and to not use any type of products o Increase in electrical activity can be stimulated with bright flashing lights and auditory stimulus
Patient education for amyotrophic lateral sclerosis (ALS)?
o Prognosis o Palliative care
Describe magnetic resonance imaging (MRI).
o 3 dimensional imaging offers really clear details about very small structures o Can be done with or without contrast dye o Very useful in visualizing the brain o Remove all jewelry and metal implants as well as pacemakers may be contraindicated o Long invasive test, approximately 50 minutes o If contrast is used, assess allergies, and renal function (BUN and creatinine), push fluids if dye is used
Patient education for multiple sclerosis?
o Avoid stress - meditate, relax o Quit smoking o Avoid extreme heat and cold o Get enough sleep - avoid over fatigue o Teach your patient how to avoid a flare up (exacerbation)
What is status epileptics?
o Classified as a seizure that lasts longer than 5 minutes OR they have multiple seizures (2 or more) without no real break and patient doesn't regain consciousness between the two o Most concerned with airway and brain activity o MEDICAL EMERGENCY because it can cause respiratory failure and risk of hypoxia which increases risk for brain injury and death
Complications for multiple sclerosis?
o Communication o Difficulty swallowing o Aspiration o Nutritional deficits
Complications of craniotomy?
o The biggestcomplication of this surgery is intracranial bleeding o Cerebral edema is also a potential complication; which is an expected finding but we have to watch it to make sure it stays within a safe range o Seizures so the patient may be placed on seizure medications such as Dilantin and Phenobarbital o Increased intracranial pressure o Blood clots
Describe a migraine headache.
o The worst type of headache o The key part of a migraine is the aura prior to getting a migraine o Aura is an individualized presentation that is proceeding by a migraine o Aura's are classified as a warning sign that you are going to get a migraine o Migraines can be hereditary but they can also be due to hormonal changes; especially, with women and their menstrual cycles as well as pregnancy o After the migraine, the patient will have extreme fatigue
Describe lumbar puncture.
o To test for meningitis o Obtains samples of CSF o Nurses should ensure any anticoagulant medications are held per the doctors order o Consent must be obtained o Sterile procedure o Color is important - cloudy is indicative of an infection o Bed rest to 4-6 hours after the procedure o Hydration is super important because a spinal headache is extremely common after the test
What is the worst type of malignant brain tumor?
Glioblastoma o Grows extremely fast o No matter how many times you remove it, it grows right back o Surgery is done to prolong patient's life
Cranial nerve 9
Glossopharyngeal
A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse plan to take? Select all that apply. a. Implement seizure precautions b. Perform neurologic checks four times a day c. Administer morphine for the report of neck and generalized pain d. Turn off room lights and television e. Monitor for impaired extraocular movements f. Encourage the client to cough frequently
A, D, E
Describe low back pain.
A very common neurologic ailment in the United States Second most common ailment in the US - 60-80% of the population will have a lower back pain episode in their lifetime
Cranial nerve 8
Acoustic
Describe post-ictal seizure.
Aftermath of a seizure, patient should remain in the side-lying position, check vital signs, assess for any injuries, do a neurological assessment Re-orient the patient Inform the doctor of this abnormal event
Medications may be helpful for early stages of Parkinson's disease. What are they?
Anti-cholinergic which dry you up and are known to help for the tremors Diphenhydramine (Benadryl)
What is multiple sclerosis?
Autoimmune disorder that affect the myelin which is the protective covering of the spinal cord Demyelination is the breakdown of the sheath which allows immune cells (T lymphocytes) to attack the brain and spinal cord
A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include? Select all that apply. a. Provide three large balanced meals daily b. Record diet and fluid intake daily c. Document weight every other week d. Offer cold fluids such as milkshakes Offer nutritional supplements between meals
B, D, E
A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include? a. Recommend a community support group b. Integrate a daily exercise routine c. Provide a walker for ambulation d. Perform ADLs for the client
C
A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia/ Which of the following is an appropriate action by the nurse? a. Teach the client to walk more quickly when ambulating b. Complete passive range-of-motion exercises daily c. Place the client on a low-protein, low-calorie diet d. Give the client extra time to perform activities
C
A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching? a. It is safe to use microwaves that are 1,200 watts or less. b. You should avoid the use of CT scans with contrast. c. You should place a magnet over the implantable device when you feel an aura occurring. d. It is recommended that you use ultrasound diathermy for pain management.
C
A nurse is providing discharge instructions to a client who has prescription for phenytoin. Which of the following information should the nurse include? a. Consider taking an antacid when on this medication b. Watch for receding gums when taking this medication c. Take the medication at the same time every day d. Provide a urine sample to determine therapeutic levels of the medication
C
A nurse is providing teaching to the partner of an older adult client who has Alzheimer's disease and has a new prescription for donepezil. Which of the following statements by the partner indicates the teaching is effective? A. This medication should increase my husband's appetite B. This medication should help my husband sleep better C. This medication should help my husband's daily function D. This medication should increase my husband's energy level
C
A nurse is reviewing the use of the meningococcal vaccine (MCV4) for the prevention of meningitis with a newly licensed nurse. Which of the following information should the nurse include? a. The vaccine is indicated to reduce the risk of respiratory infection b. The vaccine is administered in a series of four doses c. The vaccine is recommended for adolescents before starting college d. The vaccine is initially given at 2 months of age
C
What is Parkinson's disease?
Decreased dopamine in the brain; when we lose dopamine, excess acetylcholine occurs which is in charge for resting and digesting Average age for people to be diagnosed is 30's OR 60 and above Progressive process that gets worse over time, debilitating disease that affects the motor function that is characterized by 4 primary symptoms which occur due to overstimulation of the basal ganglia: o Tremors o Muscle rigidity o Bradykinesia o Postural instability
Nursing care for primary brain tumors?
Focused assessment on the neurological system Nursing diagnosis -Impaired tissue perfusion (cerebral) -Fear related to surgery -Body image Vital signs -Estimated blood loss should be included in the OR report -Patients will typically have tachycardia -Trending vital signs Urinary output -Urinary output per hour should be 30mL -Anything less than that is not adequate output Pain management Other medications -Glucocorticoids to prevent further edema or swelling in the brain -Steroids must be tapered off -Stool softeners to prevent straining because straining increases intracranial pressure -Anti-seizure medications may also be given Lab work -Monitor electrolytes especially sodium because it involves fluid movement -Monitors glucose solely because of glucocorticoids Head of the bed -30 to 45 degrees to help decrease pressure -No bending below the waste Prevent DVTs/ VTEs -Heparin, Lovenox
What is a herniated nucleus polposus (herniated disc)?
Generally, age-related and the disc between the vertebrae get weak and breakdown Herniation is connected to a severe inflammatory response If a nerve root compression is involved, numbness, tingling, and sometimes paralysis can occur in the affected extremity and patients will lose control and motor movement in the affected area
Cranial nerve 1
Olfactory
Medical treatment of amyotrophic lateral sclerosis (ALS)?
Only symptomatic relief
Cranial nerve 2
Optic
Describe the aging adult in regard to neurosensory systems.
· Brain weight and mass decline · Altered thermoregulation · Body movements and reaction time are slowed · Decline in neurotransmitters · Vascular changes which increases risk for strokes · UTI can cause sudden onset of confusion · Polypharmacy which can cause lots of symptoms that may seem neurologic in nature
Symptoms for multiple sclerosis?
o Depends on where the affected nerve fibers are o Numbness o Weakness in the limbs o Partial or complete vision loss o Double blurred vision o Tingling pain o Electric shock
Nursing interventions for meningitis?
o Droplet precautions o Neuro assessment o Vital signs o Monitor lab work o IV antibiotics and fluids o Decrease environmental stimuli o HOB 30 degrees o Pain management o Antipyretics (fever reducer)
Nursing care for multiple sclerosis?
o Evaluate for changes and progression in neuromuscular function -As it progresses, patient generally becomes bedridden o Skin assessment o ADL's and encourage patient to do as much as they can o Fatigue will be an issue but encourage patient to stay active o Range of motion o High fall risk so stress safety
Subjective assessment for meningitis?
o Excruciating headache o Photophobia o Nuclear rigidity o Chills on steroids o Lethargic
Objective assessment for meningitis?
o Fever o Extreme tachycardia o Altered lever of consciousness o Difficulty arousing Positive Brudenski's sign (not the definitive diagnostic for meningitis)
Risk factors for seizure disorders?
o Genetic o Head trauma o Increased intracranial pressure o Infection o Strokes o Brain tumors o Substance abuse (withdrawal) o Abruptly stopping seizure medications o Electrolyte imbalances o Toxins (poisoning, carbon monoxide) o Stimulation triggers
Management of headaches?
o Headache diary o Complete neurological assessment
Describe myelogram.
o Inject dye into the subarachnoid space that lights up to note different structures of the brain o Looks at swelling, various formations, and clots
Describe positron emission tomography (PET) scan.
o Lights up the entire body and shows tumors o Nuclear medicine procedure and uses glucose based radioactive tracers o NPO 6-12 hours before the procedure, after the procedure, push for increased fluids due to the dye used during the procedure to get the dye out of the system o Mainly used to detect cancer cells o Avoid sugar and glucose prior to a PET scan (at least a day or two before the scan) because it uses radioactive glucose tracers
Describe cerebral angiography.
o Looks for blockages in the brain that are indicative of strokes o Visualization for cerebral blood vessels o Iodine dye is injected through an arterial catheter o Most popular spot is the femoral artery o NPO after midnight o Ask about allergies and assess renal function o After the procedure, check distal pulse, 5 P's, temperature, vital signs, nurses must keep pressure on the site about 10-15 minutes of hard manual pressure or an arterial pressure device is used o Leg position is also important o Bed rest 6-12 hours as ordered IV hydration - flush the kidneys
Diagnostics for low back pain?
o MRI o CT o Myelograms
Signs and symptoms of herniated disc?
o Muscle spasms o Bowel control
Treatment for multiple sclerosis?
o NO cure o Aimed at managing exacerbations and speed up remission periods o Medications are used to slow the progression (interferons, immunosuppressant's, corticosteroids, plasma exchanges) to decrease spasmodic in the patient
Diagnostics of amyotrophic lateral sclerosis (ALS)?
o No single diagnostic test is definitive o MRI can help with diagnoses
Diagnostics for multiple sclerosis?
o No specific tests o Made by ruling out of other things o MRI can help but it is not definitive
Nursing care for amyotrophic lateral sclerosis (ALS)?
o Nutritional means through peg tubes (gastric feeding tube) o Focus on airway and patient will end up on ventilators o Turn every 2 hours due to skin integrity issues o Range of motion o Identify support system due to ineffective coping and strained caregiver roles
Typical appearance of Parkinson's disease?
o Stooped posture o Masked facial expression o Forward tilt of trunk o Rigidity o Flexed elbows and wrists o Reduced arm swinging o Slightly flexed hips and knees o Trembling of extremities o Shuffling, short-stepped gait
Causes of low back pain?
o Trauma o Poor body mechanics o Can be related to degenerative diseases (spinal degeneration)
Describe magnetic resonance angiography (MRA).
o Uses radio signals to get images of flowing blood (aneurysms or clots) o Contrast may or may not be used for this
Signs and symptoms of amyotrophic lateral sclerosis (ALS)?
o Voluntarily muscle loss o Paralysis o Respiratory failure
Describe computerized tomography (CT).
o With neuro issues, this is the first diagnostic test that we typically do o Gives lots of information without being too invasive o Educate the patient about claustrophobia o Note any allergies to shellfish and iodine o Prior to test, check kidney function because afterwards, we HAVE to drink a lot of water to flush out the dye o Be cautious about Metformin - must hold 24-48 hours before the procedure
Diagnostics for herniated disc?
o X-ray o CT o MRI o Myelograms
Describe pre-ictal seizure.
prior to the seizure, could be aura
