Neuro Ch. 65
Gamma-aminobutyric acid
Source: Spinal cord, cerebellum, basal ganglia, some cortical areas Action: Inhibitory Diseases/problems Associated:
Dopamine
Source: Substantia nigra and basal ganglia Action: Usually inhibitory; affects behavior (attention, emotions) and fine movement Diseases/problems Associated:
Cranial nerve 6 Abducens
Type: Motor Muscles that move the eye
Cranial nerve 3 Oculomotor
Type: Motor Muscles that move the eye and lid, pupillary constriction, lens accommodation
Cranial nerve 11 Spinal accessory
Type: Motor Sternocleidomastoid and trapezius muscles
Cranial nerve 8 Acoustic
Type: Sensory Hearing and equilibrium
Cranial nerve 1 Olfactory
Type: Sensory Sense of smell
Cranial nerve 2 Optic
Type: Sensory Visual acuity and visual fields
A client with trigeminal neuralgia (tic douloureux) asks the nurse for a snack and something to drink. Which is the best selection the nurse should provide for the client? Hot cocoa with honey and toast Vanilla pudding and lukewarm milk Hot herbal tea with graham crackers Iced coffee and peanut butter and crackers
Vanilla pudding and lukewarm milk Because mild tactile stimulation of the face of clients with trigeminal neuralgia can trigger pain, the client needs to eat or drink lukewarm, nutritious foods that are soft and easy to chew. Extremes of temperature will cause trigeminal pain.
What system functions to regulate activities of internal organs and maintain and restore internal homeostasis?
Autonomic Nervous System
The nurse is caring for a client with a thoracic spinal cord injury. As part of the nursing care plan, the nurse monitors for spinal shock. In the event that spinal shock occurs, which intravenous (IV) fluid should the nurse anticipate being prescribed? Dextran 0.9% Normal saline 5% Dextrose in water 5% Dextrose in 0.9% normal saline
0.9% Normal saline Rationale: Normal saline 0.9% is an isotonic solution that primarily remains in the intravascular space, increasing intravascular volume. This IV fluid would increase the client's blood pressure. Dextran is rarely used in spinal shock because isotonic fluid administration is usually sufficient. Additionally, Dextran has potential adverse effects. Dextrose 5% in water is a hypotonic solution that pulls fluid out of the intravascular space and is not indicated for shock. Dextrose 5% in normal saline 0.9% is hypertonic and may be indicated for shock resulting from hemorrhage or burns.
A client is admitted to the hospital for repair of an unruptured cerebral aneurysm. Before surgery, the nurse performs frequent assessments on the client. Which assessment finding would be noted first if the aneurysm ruptures? Widened pulse pressure Unilateral motor weakness Unilateral slowing of pupil response A decline in the level of consciousness
A decline in the level of consciousness Rationale: Rupture of a cerebral aneurysm usually results in increased intracranial pressure (ICP). The first sign of pressure in the brain is a change in the level of consciousness. This change in consciousness can be as subtle as drowsiness or restlessness. Because centers that control blood pressure are located lower in the brain than those that control consciousness, blood pressure alteration is a later sign. Slowing of pupil response and motor weakness are also late signs.
The nurse is caring for a client with a head injury and is monitoring the client for decerebrate posturing. Which is characteristic of this type of posturing? Abnormal involuntary flexion of the extremities Abnormal involuntary extension of the extremities Upper extremity extension with lower extremity flexion Upper extremity flexion with lower extremity extension
Abnormal involuntary extension of the extremities Rationale: Decerebrate posturing, which can occur with upper brainstem injury, is characterized by abnormal involuntary extension of the extremities. Options 1, 3, and 4 are incorrect descriptions of this type of posturing.
The nurse is assessing a client with a brainstem injury. What else should the nurse do in addition to performing the Glasgow Coma Scale? Perform arterial blood gases. Assist with a lumbar puncture. Perform a pulmonary wedge pressure. Assess cranial nerve functioning and respiratory rate and rhythm.
Assess cranial nerve functioning and respiratory rate and rhythm. Rationale: Assessment should be specific to the area of the brain involved. Assessing the respiratory status and cranial nerve function is a critical component of the assessment process in a client with a brainstem injury because the respiratory center is located in the brainstem. Options 1, 2, and 3 are not necessary based on the data in the question.
The nurse is planning care for a client with a T3 spinal cord injury. The nurse should include which intervention in the plan to prevent autonomic dysreflexia (hyperreflexia)? Assist the client to develop a daily bowel routine to prevent constipation. Teach the client that this condition is relatively minor with few symptoms. Assess vital signs and observe for hypotension, tachycardia, and tachypnea. Administer dexamethasone (Decadron) per the health care provider's prescription.
Assist the client to develop a daily bowel routine to prevent constipation. Rationale: Autonomic dysreflexia is a potentially life-threatening condition and may be triggered by bladder distention, bowel distention, visceral distention, or stimulation of pain receptors in the skin. A daily bowel program eliminates this trigger. Option 4 is unrelated to this specific condition. A client with autonomic hyperreflexia would be severely hypertensive and bradycardic. Removal of the stimuli results in prompt resolution of the signs and symptoms.
A client with myasthenia gravis is experiencing prolonged periods of weakness, and the health care provider prescribes an edrophonium (Enlon) test, also known as a Tensilon test. A test dose is administered and the client becomes weaker. How should the nurse interpret these results? This result is a normal finding. This result is a positive finding. Myasthenic crisis is present. Cholinergic crisis is present.
Cholinergic crisis is present. An edrophonium test may be performed to determine whether increasing weakness in a previously diagnosed myasthenic client is a result of cholinergic crisis (overmedication with anticholinesterase medications or myasthenic crisis (undermedication). Worsening of the symptoms after the test dose of medication is administered indicates a cholinergic crisis.
The nurse is caring for a client with a herniated lumbar intervertebral disk who is experiencing low back pain. Which position should the nurse place the client in to minimize the pain? A. Flat with the knees raised B. High Fowler's position with the foot of the bed flat C. Semi-Fowler's position with the foot of the bed flat D. Semi-Fowler's position with the knees slightly raised
D Rationale: Clients with low back pain are often more comfortable in the semi-Fowler's position with the knees raised sufficiently to flex the knees (William's position). This relaxes the muscles of the lower back and relieves pressure on the spinal nerve root. Keeping the bed flat with the knees raised would excessively stretch the lower back. Keeping the foot of the bed flat will enhance extension of the spine.
A client admitted to the hospital is suspected of having Guillain-Barré syndrome and the nurse performs an assessment. The nurse next reviews the client's medical record, expecting to note documentation of which manifestations of this disorder? Select all that apply. Dysphagia Paresthesia Facial weakness Difficulty speaking Hyperactive deep tendon reflexes Descending symmetrical muscle weakness
Dysphagia Paresthesia Facial weakness Difficulty speaking Rationale: Guillain-Barré syndrome is an acute autoimmune disorder characterized by varying degrees of motor weakness and paralysis. Motor manifestations include ascending symmetrical muscle weakness that leads to flaccid paralysis without muscle atrophy, decreased or absent deep tendon reflexes, respiratory compromise and respiratory failure, and loss of bladder and bowel control. Sensory manifestations include pain (cramping) and paresthesia. Cranial nerve manifestations include facial weakness, dysphagia, diplopia, and difficulty speaking. Autonomic manifestations include labile blood pressure, dysrhythmias, and tachycardia.
In caring for a client with myasthenia gravis, the nurse should be alert for which manifestations of myasthenic crisis? Select all that apply. Bradycardia Increased diaphoresis Decreased lacrimation Bowel and bladder incontinence Absent cough and swallow reflex Sudden marked rise in blood pressure
Increased diaphoresis Bowel and bladder incontinence Absent cough and swallow reflex Sudden marked rise in blood pressure Myasthenic crisis is caused by undermedication or can be precipitated by an infection or sudden withdrawal of anticholinesterase medications. It may also occur spontaneously. Clinical manifestations include increased diaphoresis, bowel and bladder incontinence, absent cough and swallow reflex, sudden marked rise in blood pressure because of hypoxia, increased heart rate, severe respiratory distress and cyanosis, increased secretions, increased lacrimation, restlessness, and dysarthria.
What are some of the expected changes that we see in the gerontological population?
Losses in strength and agility; changes in gait, posture, and balance; slowed reaction times and decreased reflexes; visual and hearing alterations; deceased sense of taste and smell; dulling of tactile sensations; changes in the perception of pain; and decreased thermoregulatory ability
What topics will you address when interviewing a patient about their health history when completing a neurological assessment?
Pain Seizures Dizziness (abnormal sensation of imbalance or movement) and vertigo (illusion of movement, usually rotation) Visual disturbances Weakness-when does it occur? Before activity or after? etc Abnormal sensations
What system controls mostly visceral functions?
Parasympathetic nervous system Regulated by centers in the spinal cord, brainstem, and hypothalamus
The nurse is caring for a client with a spinal cord injury who is in spinal shock. The nurse performs an assessment on the client, knowing that which assessment will provide the best information about recovery from spinal shock? Reflexes Pulse rate Temperature Blood pressure
Reflexes Rationale: Areflexia characterizes spinal shock; therefore, reflexes would provide the best information about recovery. Vital sign changes (options 2, 3, and 4) are not consistently affected by spinal shock. Because vital signs are affected by many factors, they do not give reliable information about spinal shock recovery. Blood pressure would provide good information about recovery from other types of shock, but not spinal shock.
The nurse is caring for a client after a supratentorial craniotomy. The nurse places a sign above the client's bed stating that the client should be maintained in which position? Prone Supine Semi-Fowler's Dorsal recumbent
Semi-Fowler's Rationale: After supratentorial surgery (surgery above the brain's tentorium), the client's head is usually elevated 30 degrees to promote venous outflow through the jugular veins and modulate intracranial pressure (ICP). Options 1, 2, and 4 are incorrect positions after this surgery because they are likely to increase ICP.
Serotonin
Source: Brain stem, hypothalamus, dorsal horn of the spinal cord Action: Inhibitory; helps control mood and sleep, inhibits pain pathways Diseases/problems Associated:
Norepinephrine (major transmitter of the sympathetic nervous system)
Source: Brain stem, hypothalamus, postganglionic neurons of the sympathetic nervous system Action: Usually excitatory; affects mood and overall activity Diseases/problems Associated:
Acetylcholine (major transmitter of the parasympathetic nervous system)
Source: Many areas of the brain; autonomic nervous system Action: Usually excitatory; parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerve) Diseases/problems Associated:
Enkephalin, endorphin
Source: Nerve terminals in the spine, brain stem, thalamus and hypothalamus, pituitary gland Action: Excitatory; pleasurable sensation, inhibits pain transmission Diseases/problems Associated:
The nurse caring for a client with a neurological disorder is planning care to maintain nutritional status. The nurse is concerned about the client's swallowing ability. Which food item should the nurse eliminate from this client's diet? Spinach Custard Scrambled eggs Mashed potatoes
Spinach Rationale: Raw vegetables; chunky vegetables such as diced beets; and stringy vegetables such as spinach, corn, and peas are foods commonly excluded from the diet of a client with a poor swallowing reflex. In general, flavorful, warm, or well-chilled foods with texture stimulate the swallowing reflex. Soft and semisoft foods such as custards or puddings, egg dishes, and potatoes are usually effective.
What system controls our "fight or flight" instinct and what is the major transmitter involved?
Sympathetic nervous system Main neurotransmitter is norepinephrine
The nurse has developed a plan of care for a client with a diagnosis of anterior cord syndrome. Which intervention should the nurse include in the plan of care? Change the client's positions slowly. Assess the client for decreased sensation to touch. Assess the client for decreased sensation to vibration. Teach the client about loss of motor function and decreased pain sensation.
Teach the client about loss of motor function and decreased pain sensation. Rationale: Anterior cord syndrome is caused by damage to the anterior portion of the gray and white matter. Clinical findings related to anterior cord syndrome include loss of motor function, temperature sensation, and pain sensation below the level of injury. The syndrome does not affect sensations of fine touch, position, and vibration.
Cranial nerve 12 Hypoglossal
Type: Motor Movement of the tongue
If a patient has damage to the brain stem, what areas of functioning might be affected that would be the most detrimental to the patient's well being?
The brain stem consists of the midbrain, pons, and medulla oblongata. Reflex centers for respiration, blood pressure, heart rate, coughing, vomiting, swallowing, and sneezing are also located in the medulla. The reticular formation, responsible for arousal and the sleep-wake cycle, begins in the medulla and connects with numerous higher structures. Portions of the pons help regulate respiration.
What part of the brain is responsible for the transmission of information from one side of the brain to the other.
The corpus callosum, a thick collection of nerve fibers that connects the two hemispheres of the brain. Information transferred includes sensation, memory, and learned discrimination.
Cranial nerve 4 Trochlear
Type: Motor Muscles that move the eye
Cranial nerve 5 Trigeminal
Type: Mixed Facial sensation, corneal reflex, mastication
Cranial nerve 10 Vagus
Type: Mixed Muscles of pharynx, larynx, and soft palate; sensation in external ear, pharynx, larynx, thoracic and abdominal viscera; parasympathetic innervation of thoracic and abdominal organs
Cranial nerve 7 Facial
Type: Mixed Symmetry of facial expression and muscle movement in upper and lower face, salivation and tearing, taste, sensation in the ear
Cranial nerve 9 Glossopharyngeal
Type: Mixed Taste, sensation in pharynx and tongue, pharyngeal muscles, swallowing
The nurse is caring for a client admitted to the hospital after sustaining a head injury. In which position should the nurse place the client to prevent increased intracranial pressure (ICP)? In left Sims' position In reverse Trendelenburg With the head elevated on a pillow With the head of the bed elevated at least 30 degrees
With the head of the bed elevated at least 30 degrees Rationale: The client with a head injury is positioned to avoid extreme flexion or extension of the neck and to maintain the head in the midline, neutral position. The head of the bed is elevated to at least 30 degrees or as recommended by the health care provider. The client is log rolled when turned to avoid extreme hip flexion. Therefore, options 1, 2, and 3 are incorrect.
Parietal lobe of the brain
a predominantly sensory lobe posterior to the frontal lobe. This lobe analyzes sensory information and relays the interpretation of this information to other body position in space, size and shape discrimination, and right-left orientation
Temporal lobe of the brain
located inferior to the frontal and parietal lobes, this lobe contains the auditory receptive areas and plays a role in memory of sound and understanding of language and music.
Occipital lobe of the brain
located posterior to the parietal lobe, this lobe is responsible for visual interpretation and memory.
Frontal lobe of the brain
the largest lobe, located in the front of the brain. The major functions of this lobe are concentration, abstract thought, information storage or memory, and motor function. It contains Broca's area, which is located in the left hemisphere and is critical for motor control of speech. The frontal lobe is also responsible in large part for a person's affect, judgment, personality, and inhibitions
