Med Surg 2 Neuro

what type of toothbrush should a patient use who is on long term phenytoin therapy & needs to keep good oral hygiene

a soft toothbrush

what do you check for in a patient who has a head injury?

airway patency

what is one diagnostic test used in the neurologic system

an CSF (cerebrospinal fluid) test

what are some commonly prescribed medications used for disturbances in muscle tone & motor function to reduce spasticity?

baclofen (Lioresal)

how is multiple sclerosis characterized?

by chronic, progressive deterioration in some people & by remissions and exacerbations in others

when a patient has a head injury, where & why do you assess the patient's orientation

check at cranial nerve 2, looking for pupillary response

What is the cardinal sign of increased intracranial pressure in a brain injured patient?

decrease in the level of consciousness

Levodopa is converted into what?

dopamine in the CNS where it serves as a neurotransmitter

What is decorticate posturing?

flexion into body

what is an adverse effect of levodopa?

impaired voluntary movement

what 2 drugs for parkinson's make up Sinemet?

levodopa & carbidopa

after a lumbar puncture is done on a patient, what should the patient be directed to do

lie flat in bed for several hrs

a patient that must have safety measures put in place, is said to have received, what?

long term EEG monitoring

Treatment for meningitis includes what

multiple antibiotics AKA antimicrobials

What is caused by Demyelination

multiple sclerosis

Shortly after the administration of Edrophonium how is the patients response?

muscle function improves dramatically

what are some addtl symptoms experienced by a headache

nausea, vomiting, sensitivity to light, chilliness, fatigue, irritability, diaphoresis, edema, & other signs of autonomic dysfunction

when a patient is to receive a lumbar puncture, how are they usually positioned for the procedure to take place

on the side with the knee & head flexed at an acute angle

what could be used in a seizure patient if a patient has a seizure in their sleep and what should be available for long term EEG monitoring

padded side rails and suction should be available

what seizure medication has the potential to decrease the affects of birth control?

phenytoin sodium (dilantin)

what is a common side affect of levodopa?

postural hypotension

what do you do when a patient experiences a seizure during or after an EEG?

protect the pt's airway by turning his/ her head to one side & stay with the patient to protect him from injury

Following a myelogram the nurse should include in the post procedure care assessment for:

sensation in lower extremities

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to:

shuffle with arms flexed

these 2 side effects, hypotension & uncontrollable body movements, are side effects of what medication used to treat parkinson's?

sinemet/levodopa/carbidopa

when recurrent generalized seizures occurs at such frequency that full consciousness is not regained between seizures, what is this called?

status epilepticus

what is a cause of cluster headaches

the cause is unknown, although theories support a sudden release of histamine or serotonin by the body

when planning care for a patient who has aphasia, what should you consider?

the type of aphasia the pt has so you can adapt their communication needs

Symptoms of MS are controlled with what?

the use of adrenocorticotropic hormone (ACTH)

why is diet important to a patient with parkinson's disease?

to avoid malnutrition & constipation

when taking levodopa, what is the action that is desired?

to have a decrease in muscle tremors

The nurse explains that the triad of signs of Parkinson disease is:

tremor, rigidity, bradykinesia

what is a patient teaching for someone who has seizures when trying to protect them from injury?

turn the patient to one side & remain with the patient until the seizure is over

what action increases ICP

turning patient with flexion of hip and leg

Describe an objective for a patient who's had a seizure

you would describe the seizure as completely as possible, including duration

Decerebrate posturing

-"extensor posturing"; -abduction of arms, elbow and wrist extension

Multiple Sclerosis (MS)nursing interventions include what

-Turning schedule q2h (at risk for pressure ulcers) -Bed rest (during acute exacerbations) -Rest periods especially after and between activities. -Encourage verbalizing fears about disease

What are the three signs of Cushing response/cushing triad?

-Widened pulse pressure -Bradycardia -Increased systolic blood pressure

The Glasgow Coma scale consists of what 3 neurological assessments?

-eye opening -best motor response -best verbal response

what is an important ADL practice for a patient receiving long term phenytoin therapy

-good hygiene for the mouth & teeth b/c of the side effect of edematous & enlarged gums (gingival hyperplasia)

if a patient is taking Carbamazepine (tegretol), to prevent or control their seizures, what would you advise them?

-not to drink alcohol -that it is an anticonvulsant medication

what is the max dose you want to give a patient who is taking antiparkinson's medications

10mg/day

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement?

12

How has tremors been described in parkinsons disease?

A pill rolling motion of the fingers or a resting tremor

How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork?

Agnosia

What does the nurse know about the stroke patient who has expressive aphasia?

Can understand the spoken word, but cannot speak

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem?

Can you describe the sensations you are having?"

What are the two divisions of the nervous system?

Central and the peripheral

When taking the medication carbidopa-levodopa (which is also called Sinemet, and is a combination of 2 drugs), for disorders of the neurologic system, what medicine should you not give the patient and why?

Demerol because it can cause dyskinesia (involuntary Muscle movements)

During this process the myelin sheath cells are destroyed causing an interruption or distortion of the nerve impulse so that it is slowed or blocked.

Demyelination process

This is a short acting cholinesterase inhibitor administered intravenously used to diagnose Myasthenia Gravis.

Edrophonium

what parkinson's medication is an MAOI type B

Eldepryl

if a patient is experiencing status epilepticus, what will be given to the patient

IV, valium, or atavan

Medical management for Myasthenia Gravis includes the use of Anticholinesterase drugs such as Neostigmine and pyridostigmine (Mestinon), what do these medications do?

Increase the availability of acetylcholine at the neuromuscular junction

what is an action that can increase ICP on a patient?

Lying quietly with head of bed (HOB) elevated. (semi-fowler position 30-45 degrees

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called?

Postictal period

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis?

Promotes nerve impulse transmission

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body

Proprioception

How is multiple Foci of demyelination distributed during multiple sclerosis?

Randomly in the white matter of the brainstem, the spinal cord, optic nerves and Cerebrum.

what test has a normal response while maintaining balance throughout the test with only a slight swaying motion

Romberg test

Which symptom is specific to migraine headaches or epileptic seizures?

They are preceded by an aura

How would the nurse instruct a patient with Parkinson disease to improve activity level?

To walk with hands clasped behind back to help balance

Muscle rigidity during parkinson's disease leads to what type of appearance?

a mask-like appearance of the face

a patient that is usually positioned on the side with both knees & head flexed at an acute angle to allow maximum flexion of the lumbar area for ease in performing the lumbar puncture, what procedure are they having done?

a myelogram

a neurologic assessment is extremely important in establishing what?

a pre-op baseline for post-op comparison (mental status) (LOC: level of consciousness)