Med surg II exam 2

A patient is suspected of having a brain tumor. The signs and symptoms include memory deficits, visual disturbances, weakness of right upper and lower extremities, and personality changes. The nurse recognizes the tumor is most likely located in the

Frontal lobe

A patients eyes jerk while the patient looks to the left. You all record this finding as

Nystagmus

Information provided by the patient that would helpful differentiate a hemorrhagic stroke from a thrombotic stroke includes

Sudden onset of severe headache

During neurologic testing, the patient is able to perceive pain elicited by pinprick. Based on this finding, the nurse may omit testing for

Temperature perception

Amyotrphic lateral sclerosis teaching

This is a progressive disease that eventually results in permanent paralysis, though you will not lose any cognitive function

Paralysis of lateral gaze indicated a lesion of cranial nerve

VI

Abnormal intracranial pressure, ICP

above 20 mm HG

Bacterial meningitis

acute inflammation of meningeal tissue surrounding brain and spinal cord, fall, winter, and early spring. medical emergency. mortality near 100% if untreated. Steptococcus pneumonia or Neisseria meningitidis

Seizure treatment

anti epileptic drugs, non cure, MOA- stabilizes nerve cell membranes and prevents spread of epileptic discharge

Phenytoin, dilantin

anti seizure agent, one of oldest and most commonly used. lots of side effects, notable toxicity, can do drug level for therapeutic range, pt must be on cardiac monitor during administration- dysrhythmias can occur, only mix in NS, gingival hyperplasia

Valproic acid, depakene

anticonvulsant

Gabapentin, fanatrex

anticonvulsant, mood stabilizer, adjunct for analgesia, for neuro pain, stable for diabetic neuropathies, or shingles pain, increase in CNS depression postop

Complications of increased ICP

change in LOC, change in VS, dilation of pupils, decrease in motor function, headache, vomiting, inadequate cerebral perfusion, cerebral herniation

Complex focal

change or loss of consciousness, dreamlike experience, lip smacking, loss memory during seizure

Parkinsons disease

chronic, progressive neurodegenerative disorder. Triad- tremor, bradykinesia, cogwheel. lack of dopamine

Intracranial pressure

hydrostatic force measured in the brain cerebrospinal fluid compartment. exerted by 3 components within skull- brain tissue, blood, and CSF

Most important modifiable risk factor for stroke

hypertension

Causes of subarachnoid hemorrhage

rupture of cerebral aneurysm, arteriovenous malformation, trauma, or drug abuse, cocaine, meth, sudden emotional distress

Atypical absence

staring spell that often goes unnoticed, can occur up to 100 times a day

Topiramate, topamax

sulfamate, prevention of migraine headaches, freaky hallucigenic side effects

Transient Ischemic attack, TIA

transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain. symptoms occur within an hour. most resolve. 1/3 progress to ischemic stroke

Nursing management of a patient with a brain tumor includes

Assisting and supporting the family in understanding any changes in behavior. Planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs

Drugs or diseases that impair the function of the extrapyramidal system may cause a loss of

Automatic movements associated with skeletal muscle activity

A client with cancer is scheduled for a bone scan to determine the presence of metastasis. The nurse evaluates that the teaching before the scheduled bone scan is effective when the client states:

"A substance of low radioactivity will be injected into my vein and my body inspected by an instrument to detect where it is deposited."

Subacute subdural hematoma

2-14 days of the injury, altered mental status

Normal intracranial pressure, ICP

5-15 mm HG

A patient with intracranial pressure monitoring has a pressure of 12 mm HG. The nurse understands this pressure reflects

A normal balance between brain tissue, blood, and cerebrospinal fluid

Assessment of muscle strength of older adults cannot be compared with that of younger adults because

Aging leads to a decrease in muscle bilk and strength

Vasogenic cerebral edema increases intracranial pressure by

Altering the endothelial lining of cerebral capillaries

Recurring headaches. Sharp, stabbing, and located around left eye. Left eye seems to swell and get teary when they occur

Cluster headaches

A result of stimulation of the parasympathetic nervous system is

Constriction of the bronchi, dilation of skin blood vessels, increased secretion of insulin, and relaxation of the urinary sphincters

A nursing measure that is indicated to reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is

Controlling fever with prescribed drugs and cooling techniques

The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the

Degree of collateral circulation

Common psychosocial reactions of the stroke patient to the stroke include

Depression, disassociation, and denial of severity of stroke.

The nurse is alerted to a possible acute subdural hematoma in the patient who

Develops decreased level of consciousness and a headache within 48 hours of a head injury

A nurse completes an admission assessment on a client who is diagnosed with myasthenia gravis. Which clinical finding is the nurse most likely to identify?

Difficulty swallowing saliva

what can you do drug levels on to check therapeutic range?

Dilantin, tegretol, and valproic acid

The nurse is caring for a patient with peripheral neuropathy who is going to have EMG studies tomorrow morning. The nurse should

Instruct the patient that there is no risk of electric shock

An obstruction of the anterior cerebral arteries will affect functions of

Judgement, insight, and reasoning

A patient with right sides hemiplegia and aphasia resulting from a stroke most likely has involvement of the

Left middle cerebral artery

Data regarding mobility, strength, coordination, and activity tolerance are important for the nurse to obtain because

Many neurologic diseases affect one or more of these areas

In a patient with a disease that affects the myelin sheath of nerves, such as multiple sclerosis, the glial cells affected are the

Oligodendrocytes

Angiography test determines the

Patency of the cerebral blood vessels

Cerebral endarterectomy is done to

Prevent a stroke by removing the atherosclerotic plaques blocking cerebral blood flow

Just diagnosed with parkinsons disease. Priority nursing intervention is

Promoting physical exercise and a well-balanced diet

BATS

berry aneurysm, arteriovenous malformation disease, adult polycystic kidney, trauma, stroke

Subdural hematoma

bleeding between dura mater and arachnoid, from veins, usually asymptomatic, higher incidence of death

Epidural

bleeding between the dura and inner surface of the skull caused by trauma, neurological emergency

Focal seizure

caused by focal irritations, unilateral manifestations, arise from localized brain involvement

A client has had a carotid endarterectomy. To monitor for the complication of cranial nerve dysfunction, the nurse assesses the client for:

difficulty swallowing

Carbudopa, Levodopa

dopamine antagonist, parkinsons disease, relief of tremor and rigidity, side effect impulse control disorder

Embolic stroke

embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel. commonly rapid occurrence of severe clinical symptoms

FAST

face- asymmetry, arms- left side neglect, speech- slurred/strange, time- call 911, TPA <3hrs ischemic stroke

A client is admitted with paresis of the ciliary muscles of the left eye. What function should the nurse expect to be affected?

focusing the lens on near objects

Thrombotic stroke

from injury to blood vessel wall and formation of a blood clot. lumen of blood vessel becomes narrowed and it is becomes occluded infarction occurs. large % asymptomatic

What can cause an increase in ICP?

head trauma, stroke, subarachnoid hemorrhage, brain tumor, inflammation, hydrocephalus, or brain tissue damage from other cause. cerebral edema

Multiple sclerosis

heterogenous with variable clinical features. demyelination, chronic inflammation, gliosis, scarring in CNS, damage to myelin sheath of neurons in the brain and spinal cord,

3% normal saline

hypertonic solution, osmotic effect used to combat cerebral edema, can control ICP, staple in neurosurgical ICUs, go to for severe cerebral edema, give slowly, monitor, check labs often, osmosis- draw fluid back into vasculature from brain tissue

Ischemic stroke

inadequate blood flow to the brain from partial or complete occlusion of an artery. 80% of all strokes. Thrombotic and embolic

When performing a neurological check on a client with a head injury, the nurse identifies a diminished corneal reflex in the left eye. Appropriate nursing care for a client with an absent corneal reflex includes:

instilling artificial tears frequently

Subarachnoid Hemorrhage, SAH

internal bleeding into cerebral spinal fluid space, surface of brain, caused by rupture of cerebral aneurysm

Stroke

interruption of blood flow into the brain from ischemia or hemorrhage that results in death of brain cells. Blood supplied to brain by internal carotid arteries and the vertebral arteries

Subarachnoid hemorrhage SAH

intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain. silent killer.

Generalized seizures

involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain, no warning or aura

Chushings triad, increased intracranial pressure

irregular respirations, systolic hypertension with widened pulse pressure, and bradycardia

A nurse is assessing a client with Parkinson disease. Which assessment finding indicates the presence of bradykinesia?

lack of spontaneous movement

Increase in intracranial pressure

life-threatening, diminished CPP, increases risk of brain ischemia and infarction, associated with poor prognosis

Tonic clonic seizures

loss of consciousness, stiffness- tonic 10-20 sec, subsequent jerking- clonic 30-40 sec, dilated pupils, hyperventilation, apnea, cyanosis, tongue or cheek biting

Tension

most common, bilateral, pressing and tightening, stress, headband, mild/moderate intensity. treatment- aspirin, acetaminophen, or NSAID alone or with sedative, muscle relaxant, or tranquilizer

Mannitol, Osmiltrol

osmotic diuretic, renal failure, edema, ICP, toxic overdose, emergency drug for acute herniation, monitor serum osmolarity levels, crystallization- big problem. ICP patients, must be given with a filter

An older adult who was in a motor vehicle collision is brought to the emergency department via ambulance. The client exhibits a decreased level of consciousness, and the nurse identifies serosanguinous drainage from the client's left ear. What should the nurse do?

place a sterile pad over the external ear

General manifestations of seizures

proximal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function, often symptoms of an underlying illness

Cluster

rare, sharp or stabbing pain, repeatedly for weeks to months, periods of remission. treatment- drug therapy not as useful, prophylactic drugs

Migraine

recurring, unilateral or bilateral throbbing pain, triggering event or factor, neurologic and autonomic nervous system dysfunction. treatment- anaglesics, triptans, and preventative treatment

Simple focal

remains unconscious with unusual feelings and sensations

Hemorrhagic stroke

result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles

Absence, mal petit

usually occurs only in children, precipitated by flashing lights and hyperventilation, daydreaming face, altered consciousness

Gold standard for monitoring ICP

ventriculostomy. specialized catheter inserted into right lateral ventricle and coupled to an external transducer

Intracerebral hemorrhage

bleeding within the brain caused by a rupture of a vessel. sudden onset of symptoms with progression over mins to hours

number one cause of CVA

hypertension

The nurse is performing a neurological assessment on a client and is completing the Glasgow Coma Scale (GCS). What components make up this assessment tool? Select all that apply

verbal, motor, and eye opening

Chronic subdural hematoma

weeks to months after injury

Vagal nerve stimulants

when surgery not feasible, exact mechanism unknown, thought to interrupt the synchronization of epileptic brain wave activity and excessive discharge of neurons

Acute subdural hematoma

within 24-48 hours of injury, immediate deteriotation, cerebral edema,

epidural

arterial

Bacterial meningitis diagnosis

blood culture, CT scan, X rays of skull, MRI, verified by lumbar puncture and analysis of CSF

Atherosclerosis

hardening and thickening of the arteries, major cause of ischemic stroke. can lead to thrombus formation and contribute to emboli

Imetrex, Sumatriptan

migraine and cluster headache. staple for migraine treatment. teach pt to not run out, could save from ER trip

subdural

venous

Tergetol, carbamazepine

anticonvulsant, tonic clonic, more common

Levetiracem, Keppra

anticonvulstant, tonic-clonic, complex partial, mixed seizures, common

Glasgow coma scale

assessing degree of impaired consciousness and cranial nerve assessment, pupil evaluation, and motor sensory testing

A client who sustained a severe head injury remains unconscious. During the client's assessment, the nurse observes bleeding from the left ear and rhinorrhea. The nurse concludes that drainage from the ear and nose indicates a:

basilar fracture