Unit 3 - Neuro Diseases
A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: electromyography (EMG). Doppler scanning. Doppler ultrasonography. quantitative spectral phonoangiography.
electromyography (EMG).Explanation:To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.
A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following? Acetylcholine Serotonin Dopamine Norepinephrine
Dopamine Explanation: Parkinson's disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglion region. The loss of dopamine stores results in more excitatory neurotransmitters (acetylcholine) than inhibitory transmitters (dopamine). Serotonin and norepinephrine are not involved.
Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)? Serotonin Glutamate Epinephrine Dopamine
Glutamate Explanation: Excessive levels of the neuro-excitatory neurotransmitter glutamate have been implicated in the neurodegenerative diseases such as ALS, Huntington's disease, and the sequelae of strokes.
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?Discourage the client from doing any range-of-motion (ROM) exercises. Have the client sit up in a chair as much as possible. Logroll the client from side to side. Elevate the head of the bed to 90 degrees.
Logroll the client from side to side. Explanation:Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.
A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? Homans' sign Back pain when the knees are flexed Atrophy of the lower leg muscles Pain radiating down the posterior thigh
Pain radiating down the posterior thigh Explanation: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, lower back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis.
A client comes to the clinic reporting low back pain and muscle spasms. He states, "The pain seems to travel into my hip and down to my leg." A herniated lumbar disk is suspected. Which of the following would help to confirm the suspicion? Select all that apply. Postural deformity Muscle weakness Negative straight leg test Altered tendon reflexes Increased pain with bed rest
Postural deformity Muscle weakness Altered tendon reflexes Explanation: A herniated lumbar disk manifests with pain aggravated by actions that increase intraspinal fluid pressure, such as bending, lifting, or straining. The problem is relieved by rest. Typically, there is a postural deformity and results of the straight leg test are positive. Muscle weakness, altered tendon reflexes, and sensory loss also are noted.
A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? Riluzole Baclofen Dantrolene sodium Diazepam
Riluzole Explanation: Riluzole, a glutamate antagonist, has been shown to prolong survival for persons with ALS for 3 to 6 months.
The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? Slows the progression of the disease Replaces dopamine Relieves symptoms of dyskinesia Prevents side effects from carbidopa-levodopa
Slows the progression of the disease
A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following? Medication needs to be adjusted to higher doses. The client is having an exacerbation. The client is exhibiting signs of medication overdose. The disease has entered the late stages.
The disease has entered the late stages. Explanation: In late stages, the disease affects the jaw, tongue, and larynx; speech is slurred; and chewing and swallowing become difficult. Rigidity can lead to contractures. Salivation increases, accompanied by drooling. In a small percentage of clients, the eyes roll upward or downward and stay there involuntarily (oculogyric crises) for several hours or even a few days. Options A, B, and C are therefore incorrect.
Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply. Postural instability Bradykinesia Tremor Rigidity Intellectual decline
Tremor Rigidity Bradykinesia Postural instability Cardinal signs of Parkinson's disease are tremor, rigidity, bradykinesia, and postural instability. Although mental status changes can occur over the course of the disease, intellect is usually not affected.
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action? Keeping a pillow under the client's knees at all times Placing the client in semi-fowler's position maintaining bed rest for 72 hrs after the laminectomy Turning the client from side to side, using the logroll technique
Turning the client from side to side, using the logroll technique Explanation: To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the logroll technique. (Twisting after a laminectomy could injure the spine.) After surgery, the nurse shouldn't put anything under the client's knees or place the client in semi-Fowler's position because these actions increase the risk of deep vein thrombosis. Typically, the client is allowed out of bed by the first or second day after a laminectomy.
A patient is diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease. The nurse understands that the symptoms of the disease will begin in what way? Ascending paralysis Numbness and tingling in the lower extremities Weakness starting in the muscles supplied by the cranial nerves Jerky, uncontrolled movements in the extremities
Weakness starting in the muscles supplied by the cranial nerves The chief symptoms are fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination. In about 25% of patients, weakness starts in the muscles supplies by the cranial nerves, and difficulty in talking, swallowing and ultimately breathing occurs
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Parkinson disease Amyotrophic lateral sclerosis Alzheimer disease Huntington disease
Amyotrophic lateral sclerosis Explanation: Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.
Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Impaired urinary elimination Imbalanced nutrition: Less than body requirements Ineffective airway clearance Risk for injury
Ineffective airway clearance Explanation: In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes the highest priority. Although Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, and Risk for injury are also appropriate nursing diagnoses, they aren't immediately life-threatening.
A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance? Make sure the client is sitting with the head of bed elevated to 90 degrees. Assist the client into a comfortable position and stay alert for coughing, which signifies aspiration. There are no special precautions for the client with Parkinson's disease. Clients with Parkinson's disease shouldn't have liquids; remove them from the dinner tray before serving food to the client.
Make sure the client is sitting with the head of bed elevated to 90 degrees. Explanation: Clients with Parkinson's disease are at risk for aspiration; therefore, the nurse should instruct the ancillary staff member to make sure the head of the client's bed is elevated to 90 degrees before assisting the client with eating. A client doesn't always cough when he aspirates. A client with Parkinson's disease needs fluids to maintain fluid balance. Aspiration is a great concern with Parkinson's disease; therefore; the staff should take precautions to prevent this complication.
A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? Ask the client if there is pain on ambulation. Ask if the client can walk. Have the client lie on the back and lift the leg, keeping it straight. Ask if the client has had a bowel movement.
Have the client lie on the back and lift the leg, keeping it straight .Explanation:A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.
A client who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The client and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the client's medication regimen? The client is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident. The client's temporary improvement in status is likely unrelated to levodopa-carbidopa. Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.
Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment. Explanation: The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time. However, a "honeymoon period" of treatment is not known.
The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? Drugs administered may not cause the requisite therapeutic effect. Clients generally do not adhere to the drug regimen. Clients take an assortment of different drugs. Drugs administered may cause a wide variety of adverse effects.
Drugs administered may cause a wide variety of adverse effects. Explanation: Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Dyskinesia Bradykinesia Micrographia Dysphonia
Dyskinesia Explanation:Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.
A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? Help the client assume a more comfortable position. Provide teaching on nonpharmacologic measures to control pain. Notify the physician of the client's pain. Administer hydrocodone (Vicodin) as ordered.
Help the client assume a more comfortable position. Explanation: The nurse should first help the client assume a more comfortable position. After doing so, the nurse may administer pain medication as ordered. Next, the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as necessary. If the client's pain isn't relieved after taking these actions, the nurse should notify the physician of the client's pain issues.
A nurse is working on a surgical floor. The nurse must logroll a client following a: laminectomy. thoracotomy. hemorrhoidectomy. cystectomy.
laminectomy. Explanation: The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or may be assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery.