Test 2 neuro ch 68,69,70

Tic douloureux

(trigeminal neuralgia) is manifested by pain in the areas of the fifth (trigeminal) cranial nerve. from what condition

apnea absence of brain stem reflexes coma

3 things to determine brain death

Trigeminal neuralgia

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder?

turning frame

A ____________ is used to change the client's position without altering the alignment of the spine.

cast and a cervical

A _____________&_____________ collar are used to immobilize the injured portion of the spine

Administration of rifampin Administration of ciprofloxacin hydrochloride Administration of ceftriaxone sodium

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 this student?

infection

A common precipitating event for myasthenic crisis is

base

A fracture of the ________ of the skull is referred to as a basal skull fracture

closed (blunt)

A traumatic brain injury, _______________ occurs when the head accelerates and then rapidly decelerates or collides with another object (e.g., a wall, the dashboard of a car) and brain tissue is damaged but there is no opening through the skull and dura

IVIG, plasmapheresis

Administering _____, preparing for ___________, and ensuring adequate nutritional support are important and appropriate interventions, with the treatment of myasthenic crisis but maintaining adequate respiratory status or support is the priority during the crisis.

eye patch

An _________ to the affected eye would help the client with double vision due to MS see more clearly, thus promoting safety.

making openings through the skull (burr holes)

An epidural hematoma is considered an extreme emergency; marked neurologic deficit or even respiratory arrest can occur within minutes. Treatment consists of ___________________________________________ to decrease intracranial pressure emergently, remove the clot, and control the bleeding.

24

An important component of nursing care for the client with meningitis is instituting infection control precautions until _____ hours after initiation of antibiotic therapy. Oral and nasal discharge is considered infectious. This client may well experience photophobia, so the lighting should be kept dim.

30 to 60

Areflexia is a loss of sympathetic reflex activity below the level of injury within _____to____minutes of a spinal injury.

rapid, decrease,slows

As brain compression increases, respirations become ______, BP may_________, and the pulse ______ further. .

pounding headache, profuse sweating, nasal congestion, piloerection (goose bumps), bradycardia, and hypertension

Autonomic dysreflexia is characterized by a .

T6

Autonomic dysrelexia, It occurs in cord lesions above_____ after spinal shock has resolved;

ears or the nose.

Basilar skull fractures are suspected when cerebrospinal fluid escapes from the

7th cranial nerve (facial nerve)

Bell palsy is caused by the unilateral inflammation of the __________ cranial nerve which results in weakness or paralysis of the facial muscles on the affected side.

mannitol

Cerebral edema can be treated with

48-72hr

Cerebral edema usually peaks at ____to____hrs after injury

True

Concussion is the condition of temporary loss of neurological function with no apparent structural damage to the brain. TRUE FALSE

absent and the extremities are flaccid.

During the period immediately following a spinal cord injury, spinal shock occurs. In spinal shock, all reflexes are

multiple sclerosis.

Fatigue and depression are associated with

resting in air condtioin

Fatigue is a common symptom of patients with MS. Lowering the body temperature by _____________________helps

2 to 4 hours

Fever in the client with a TBI can be the result of damage to the hypothalamus, cerebral irritation from hemorrhage, or infection. The nurse monitors the client's temperature every______________-_________hrs .

DVT, orthostatic hypotension, and autonomic dysreflexia.

For a spinal cord-injured patient, based on the assessment data, potential complications that may develop include

nose, pharynx, or ears,

Fractures of the base of the skull tend to traverse the paranasal sinus of the frontal bone or the middle ear located in the temporal bone . Therefore, they frequently produce hemorrhage from the_______________,__________________and_________and blood may appear under the conjuntiva

True

Herpes simplex virus is the most common cause of acute encephalitis in the United States. TRUE FALSE

Guillain-Barre syndrome

Hyporeflexia and weakness of the lower extremities are associated with

the head is stabilized in neutral position by one person while another notifies the neurosurgeon.

If one of the pins of Halo became detached, what action should the nurse take

temporal lobe

If the _________ lobe is involved in a concusion the patient will most likely have no recolection of incident

3

In a grade ____concussion there is a loss of consciousness lasting from seconds to minutes.

absent, fall,failure

In spinal shock, the reflexes are _________, BP and heart rate_____, and respiratory _________ can occur.

3

It can take up to _____years after a major brain trauma to reach maxium abilites

Primary Progressive MS

MS Disease progression from onset, without plateaus or remissions or with occasional plateaus and tempory minor improvments

BP and heart rate.

Manifestations of neurogenic shock include decreased

Vasopressin (Pitressin)

Med given to decrease heart rate

controlling seizures and increased intracranial pressure

Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at

False

Meningeal irritation is suspected when a patient exhibits a negative, bilateral Kernig sign. TRUE FALSE

mutliple sclerosis

Most patients diagnosed with ________ _________ have a relapsing-remitting course.

Brudzinskis sign.

Neck flexion producing flexion of knees and hips correlates with a positive

TRUE

Non depressed skull fractures do not require surgery true or false

help control ICP

Often patient with TBI or placed into a drug induced coma for what reason

thoracic

Paraplegia occurs with injuries at the ______ level.

dependent

Patients with a lesion at C4 are fully dependent or independent for elimination.

rifampin, ciprofloxacin hydrochloride, or ceftriaxone sodium.

People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using

bacterial meningitis.

Positive Homans sign (pain upon dorsiflexion of the foot) and negative Rombergs sign (inability to stand with eyes closed and arms extended) are not expected assessment findings for the patient with

11 to 12

Prevention by meningococcal vaccine to youth ____to____years of age; booster at 16. First year college students and members of the military

myasthenia gravis

Ptosis and diplopia are associated with

unilateral pupil

Pupilary sign of TBI

FYI

Scalp wounds are potential portals of entry for organisms that cause intracranial infections. Therefore, the area is irrigated before the laceration is sutured to remove foreign material and to reduce the risk for infection

slowing of the heart rate (bradycardia), increasing systolic BP, and widening pulse pressure

Signs of increasing ICP include .

FYI

Symptoms are caused by the expanding hematoma. EDHs are often characterized by a brief loss of consciousness, followed by a lucid interval in which the patient is awake and conversant.

high

Tetraplegia results in the paralysis of all extremities when there is a ______ cervical spine injury

2 hours.

The feet are prone to footdrop; therefore, various types of splints are used to prevent footdrop. When used, the splints are removed and reapplied every

True

The initial manifestation of myasthenia gravis in most patients involves the ocular muscles. True or False

least

The lowest score of 3 on the Glasgow Coma Scale indicates the _______ responsive level of consciousness.

motor vehicles crashes

The most common cause of SCI is

Overmedication

The most common cause of cholinergic crisis includes which of the following?

falls

The most common causes of traumatic brain injury are

Rhinosinusitis

The most common predisposing conditions for brain abscesses among immunocompetent adults are otitis media and ________________.

sacrum

The most common sites for pressure ulcers, a significant complication of spinal cord injury, are over the ischial tuberosity, the greater trochanter, the __________, and the occiput.

edrophonium (Tensilon) test.

The most useful and reliable diagnostic test for myasthenia gravis is the

B

The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest? A) Taking a hot bath at least once daily B) Resting in an air-conditioned room whenever possible C) Increasing the dose of muscle relaxants D) Avoiding naps during the day

Muscle weakness and hyporeflexia of the lower extremities

The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis?

A

The nurse is planning discharge education for a patient with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. What would the nurse be correct in teaching the patient to avoid? A) Washing his face B) Exposing his skin to sunlight C) Using artificial tears D) Drinking large amounts of fluids

True

The oral disease-modifying agent fingolimod, recently approved by the FDA, has shown to decrease relapse rates in multiple sclerosis by approximately 50%. True or false

True

The person with tetraplegia or paraplegia must not remain in any position for longer than 2 hours to prevent the formation of pressure ulcers. TRUE FALSE

young age male gender alcohol and drug use

The predominant risk factors for SCI include

mosquito

The primary vector in North America that is responsible for transmitting several types of viruses that cause encephalitis is the _______________.

apnea

The three cardinal signs of brain death on clinical examination are coma, the absence of brainstem reflexes and, ____________.

four times a day

To prevent disuse syndrome, ROM exercises must be provided at least _____________________, and care is taken to stretch the Achilles tendon with exercises.

Vasopressin

Treatment of cerebral edema can be treated with what medication if they are experiencing hypotention

FALSE

Trigeminal neuralgia (Tic Douloureux) is a condition of the 12th cranial nerve characterized by paroxysms of sudden pain.

First, the dura becomes more adherent to the skull with increasing age. Second, many older adults take aspirin and anticoagulants as part of routine management of chronic conditions.

Two major factors place older adults at increased risk for hematomas.

stabalization of cervial spine is recommened with head injury until it is ruled out no further injuires to spine from head injury

WHy should a cervical spine injury be ruled out with a head injury?

FYI

WIth treatment of Bells Palsy After the sensitivity of the nerve to touch decreases and the patient can tolerate touching the face, the nurse can suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling, may be performed with the aid of a mirror to prevent muscle atrophy.

elderly due to bloodthinners often perscribed

What part of our population is at an elevated risk for epiduaral hematoma

Babinski's reflex, hyperreflexia, and spasticity

When spinal shock subsides, the client will demonstrate positive ______________________________of all four extremities.

Multiple sclerosis

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?

Autonomic dysreflexia

You are a neurotrauma nurse working in a neuro ICU. What would you know is an acute emergency and is seen in clients with a cervical or high thoracic spinal cord injury after the spinal shock subsides?

True

Young age, male gender, and alcohol and drug use are risk factors for spinal cord injury. TRUE FALSE

(CT) scan

_______ can be used to diagnose a skull fracture.

Huntington

_________ disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia.

Creutzfeldt-Jakob

_________ disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

Parkinson

_________ disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain.

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

8

a glaslow score of___ or less typically indicates an unconscious patient

nerurogenic shock

caused by loss of fuction of ANS blood pressure, heart rate and cardiac output decrease venous pooling because of peripheral vasodilation paralyzed portions of body dont perspire

Halo

devices provide immobilization of the cervical spine while allowing early ambulation.

Chronic Traumatic Encephalopathy (CTE)

form of dementia caused by repeated head trauma such as concussions

Nucal rigidity

inability to flex head forward

Hyperthermia

increases the metabolic demands of the brain and may indicate brain stem damage.

Meningitis

inflammation of the meninges

Secondary Progressive MS

initial relapsing-remitting MS that suddenly begins to have decline without periods of remission

difuse axonal injury (DAI)

is associated with prolonged traumatic coma; it is more serious and is associated with a poorer prognosis than a focal lesion

IV Tensilon

is used to diagnose myasthenia gravis.

hydrolozine

medication commonly given for autnomic dysrelexia to lower bp

atropine

what can u give to increase a heart rate

open (penetrating)

what type of traumatic brain injury, occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path or when blunt trauma to the head is so severe that it opens the scalp, skull, and dura to expose the brain.

Relapse-remitting MS

25% of ms patients. There are unpredictable relapes during which new symptoms appear or existing symptoms become more severe. this can last for varying periods and there is partial or total remission. the disease may be inactive for months or years. common amoung younger people with the disease.

Myasthenia Gravis Treatment

4. acetylcholinesterase inhibitors, steroids, immunosuppressants, IVIG, plasmapheresis

comminuted

A ___________________ skull fracture refers to a splintered or multiple fracture line

generalized muscle weakness, respiratory impairment, and excessive pulmonary secretion that may result in respiratory failure

A cholinergic crisis, which is essentially a problem of overmedication, results in severe

Initiate isolation precautions

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first?

B

A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck and tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection? A) Negative Brudzinskis sign B) Positive Kernigs sign C) Hyperpatellar reflex D) Sluggish pupil reaction

fiber,30,daily muscle stretching

A patient diagnosed with MS should be encouraged to increase the ______ in his or her diet and void ______ minutes after drinking to help train the bladder. The patient should participate in to help alleviate and relax muscle spasms.

daily weights

A record of____________is maintained for the client with a traumatic brain injury, especially if the client has hypothalamic involvement and is at risk for the development of diabetes insipidus

true

Basilar skull fractures are suspected when cerebrospinal fluid escapes from the ears and the nose.

surgical resection

Brain abcess TX

Facial pain in the areas of the fifth cranial nerve

While performing an initial nursing assessment on a client admitted with suspected tic douloureux (trigeminal neuralgia), for which of the following would the nurse expect to observe?

The sudden increase in BP can raise the ICP or rupture a cerebral blood vessel.

Why is autonomic dysreflexia consisdered a emergency with a patient who has had a spinal cord injury?

Battle's sign

With fractures of the base of the skull, an area of ecchymosis (bruising) may be seen over the mastoid and is called

Otorrhea

__________ means leakage of CSF from the ear

Decadron (Dexamethasone)

___________ is an anti-inflammatory medication used to decrease inflammation in both SCI and head injury.

Azathioprine

___________ is an immunosuppressant that's sometimes used to control myasthenia gravis symptoms.

Guillian-Barre

____________ syndrome is an autoimmune attack on myelin, a complex substance that covers nerves.

propofal (Diprivan)

medication often used to place pt in drug induced coma. Has short half life so can be reversed quickly to assess neuro checks

3 and 8

A glaslow score between_______-______ is generally accepted as indicating a severe head injury

9 to 12

A glaslow score of ___-___ is moderate TBI

3 to 8

A glaslow score of ____-____ is severe TBI.

3

A glaslow score of _____ indicates severe impairment of neurologic function, deep coma, brain death, or pharmacologic inhibition of the neurologic response

13 to 15

A glasow score of ___-___ is classified as mild TBI,

false

A grade 2 concussion results in any loss of consciousness lasting from seconds to minutes.

D

The nurse is creating a plan of care for a patient who has a recent diagnosis of MS. Which of the following should the nurse include in the patients care plan? A) Encourage patient to void every hour. B) Order a low-residue diet. C) Provide total assistance with all ADLs. D) Instruct the patient on daily muscle stretching.

Traction with weights and pulleys

______________________ is applied to provide correct vertebral alignment and to increase the space between the vertebrae.

Guillian-Barre S/S

starts with weakness of lower extremities and gradually progresses to upper extremities and facial muscles. Recovery is slow and can take years. "ground to brain"

A

A patient diagnosed with Bells palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions? A) Applying a protective eye shield at night B) Chewing on the affected side to prevent unilateral neglect C) Avoiding the use of analgesics whenever possible D) Avoiding brushing the teeth

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

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?

C

A patient with Guillain-Barr syndrome has experienced a sharp decline in vital capacity. What is the nurses most appropriate action? A) Administer bronchodilators as ordered. B) Remind the patient of the importance of deep breathing and coughing exercises. C) Prepare to assist with intubation. D) Administer supplementary oxygen by nasal cannula.

(linear)

A simple ________skull fracture is a break in the continuity of the bone.

Spinal shock

A sudden depression of reflex activity below the level of spinal injury Muscular flaccidity, lack of sensation and reflexes

B

A patient with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine (Tegretol) for pain relief. What principle applies to the administration of this medication? A) Tegretol is not known to have serious adverse effects. B) The patient should be monitored for bone marrow depression. C) Side effects of the medication include renal dysfunction. D) The medication should be first taken in the maximum dosage form to be effective.

Identification, prevention, and treatment

________________,___________________&___________________ of secondary injury are the main foci of early management of severe TBI. Contributors to this process include intracranial pathologic processes such as intracranial hemorrhage, cerebral edema, intracranial hypertension, hyperemia, seizures, and vasospasm

Secondary brain injury

__________________ evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen to the cells

Depressed

________________________ skull fractures occur when the bones of the skull are forcefully displaced downward, and can vary from a slight depression to bones of the skull being splintered and embedded within brain tissue.

Trigeminal neuralgia

_________________________, a painful disorder of one or more branches of cranial nerve V (trigeminal), produces paroxysmal attacks of excruciating facial pain. Attacks are precipitated by stimulation of a trigger zone on the face. Triggering events may include light touch to a hypersensitive area, a draft of air, exposure to heat or cold, eating, smiling, talking, or drinking hot or cold beverages. It occurs most commonly in people older than age 40.

MS

_______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.

primary head injury

_______________ is defined as the consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries (e.g., contusions, lacerations, external hematomas, and skull fractures), as well as possible focal brain injuries from sudden movement of the brain within the cranial vault (e.g., subdural hematomas (SDHs), concussion, diffuse axonal injury [DA