Chapter 48 - CNS Exam Flashcards
Contralateral hemiparesis
Weak on opposite site
Ipsilateral hemiplegia
Paralyzed on same side
Quadriplegia
All four extremities paralyzed
Paraplegia
Paralyzed lower extremities
Photophobia
Sensitive to light
Bradykinesia
Slow movement
Craniotomy
Surgical opening in the skull
Encephalitis
Inflammation of the brain
Nuchal rigidity
Neck pain and stiffness
Prodromal
Warning sign
Mannitol
Osmotic diuretic
Tacrine (Cognex)
Cholinesterase inhibitor
Carbamazepine (Tegretol)
Anticonvulsant
Dexamethasone (Decadron)
Corticosteroid
Levodopa/carbidopa (Sinemet)
Converts to dopamine in the brain
Primary symptom of Stage 1 Alzheimer’s
Forgetfulness
Primary symptom of Stage 2 Alzheimer’s
Confused
Primary symptom of Stage 3 Alzheimer’s
Ambulatory dementia
Primary symptom of Stage 4 Alzheimer’s
Terminal
Unconscious at accident scene
Epidural bleed
Polyuria and polydipsia following head injury
Diabetes insipidus
Hypotension, loss of sympathetic function
Spinal shock
Nuchal rigidity
Meningitis
High blood pressure, bradycardia, diaphoresis
Autonomic dysreflexia
Brief period of starving
Absence seizure
Automatic repetitive movement such as picking or lip smacking
Complex partial seizure
Status epilepticus
Continuous seizure
Cushing’s triad
Increased intracranial pressure
Cerebral vasoconstriction followed by vasodilation
Migraine
Which of the following settings is the most therapeutic for an agitated patient with a head injury?
a) A day room with family visitors and a variety of caregivers
b) A semiprivate room with one or two consistent caregivers
c) A ward with other patients who have head injuries and volunteers to assist with needs
d) A hallway near the nurse’s station with adequate sensory stimulation
b) A semiprivate room with one or two consistent caregivers
Decreasing level of consciousness is a symptom of which of the following physiological phenomena?
a) Increased intracranial pressure (ICP)
b) Sympathetic response
c) Parasympathetic response
d) Increased cerebral blood flow
a) Increased intracranial pressure (ICP)
Which of the following blood pressure changes alerts the nurse to increasing ICP, and should be reported immediately?
a) Gradual increase
b) Rapid drop followed by gradual increase
c) Widening pulse pressure
d) Rapid fluctuations
c) Widening pulse pressure
Which of the following nursing interventions will help prevent a further increase in ICP?
a) Encourage fluids
b) Elevate the head of the bead
c) Provide physical therapy
d) Reposition the patient frequently
b) Elevate the head of the bed
A 90-year-old nursing home resident with stage 2 Alzheimer’s disease is found alone and crying in the dining room. She says she lost her mother and doesn’t know what to do. Which response by the nurse will help calm the resident?
a) “Remember your mother has been dead for 30 years. You forgot again didn’t you?”
b) “I’m sorry you lost your mother; let’s go try and find her.”
c) “Are you feeling frightened? I’m here and I will help you.”
d) “You are 90 years old. It is impossible for your mother to still be living. I know if you try, you can figure out what to do.”
c) “Are you feeling frightened? I’m here and I will help you.”
A patient asks the nurse what side effects to expect from a muscle relaxant medication that has been prescribed. Which of the following side effects should the nurse relate?
a) Hypoglycemia
b) Hypotension
c) Drowsiness
d) Dyspnea
c) Drowsiness
A nurse caring for a patient with a herniated lumbar disk develops a plan of care for impaired mobility related to nerve compression. Which patient outcome indicates that the plan has been successful
a) The patient rates the pain at 3 to 4 on a 0-to-10 scale
b) The patient has full range of motion of the upper extremities
c) The patient demonstrates correct self-administration of analgesics
d) The patient is able to ambulate 25 feet without pain
d) The patient is able to ambulate 25 feet without pain
Which of the following problems during the immediate postoperative course following lumbar microdiskectomy should be reported to the physician immediately?
a) Incisional pain
b) Two-inch area of bleeding on dressing
c) Inability to move affected leg
d) Muscle spasm of affected leg
c) Inability to move affected leg
A patient with a brain tumor is admitted to the medical unit to begin radiation treatments. Which nursing action should take priority?
a) Pad the patient’s side rails
b) Assess the patient’s pain level
c) Teach the patient what to expect during radiation treatments
d) Place the patient in isolation
a) Pad the patient’s side rails
Which nursing interventions can help prevent falls in a patient with Parkinson’s disease? (Select all that apply)
a) Keep the patient’s call light within reach
b) Apply a soft vest restraint when the patient is in bed
c) Avoid use of throw rugs
d) Maintain the patient’s bed in a low position
e) Encourage the patient to be independent for as long as possible
f) Provide a cane or walker for ambulation
a, c, d, f
The nurse is counseling a young woman with a spinal cord injury at C7. Which of the following birth control options would the nurse recommend for this client?
a) Condom
b) Oral contraceptives
c) Diaphragms
d) Norplant
e) Intrauterine device
f) No birth control is needed since she will be infertile
a, d
An inflammation of the brain and spinal cord that may be caused by either bacterial or viral infections
Meningitis
Type of meningitis that is a serious infection. Spread by direct contact with discharge from the respiratory tract of an infected person
Bacterial meningitis
Type of meningitis that is more common and rarely serious
Viral meningitis
Prevention of meningitis?
Hib vaccine and pneumonia vaccine
What is the etiology of meningitis
Generally begins in another area such as the upper respiratory tract, enters the blood, and invades the CNS
Signs and symptoms of meningitis?
Severe headache, fever, photophobia, petechial rash, nuchal rigidity, nausea, vomiting, encephalopathy
What is a positive Kernig’s sign?
After flexing the knee 90 degrees, trying to extend it all the way will cause hamstring pain
What is a positive Brudzinski’s sign?
When flexing the neck downward, the knees will flex and there will be pain in the neck
What are some complications of meningitis?
Hydrocephalus
Seizures
Respiratory impairment
Neurological deficits
How do you diagnose meningitis?
Lumbar puncture, look at the CSF
What will the CSF look like with bacterial meningitis?
Fluid is cloudy from the increase in WBC
What will the CSF look like with viral meningitis?
Fluid is clear, but the WBC count is elevated
Therapeutic interventions for meningitis?
Antibiotics(bacterial) Antipyretics (for fever) Cooling blanket (for fever) Dark quiet environment Analgesics Antiemetics Isolation
Inflammation of brain tissue in a local area
Encephalitis
Signs and symptoms of encephalitis?
Headache, fever, nausea, vomiting, nuchal rigidity, confusion, decreased LOC, seizures, photophobia, tremors
(Very similar to meningitis)
what is ataxia?
lack of muscle coordination
What tests are used to diagnose encephalitis?
CT scan, MRI, lumbar puncture, and EEG
Breakdown of blood after cerebral hemorrhage results in ___-colored CSF
yellow
Therapeutic interventions for encephalitis?
Analgesics Antipyretics Anti-virals Neuro assessment Symptomatic care
Is there a treatment for insect borne encephalitis?
No
What med is given for herpes simplex encephalitis?
Acyclovir (zovirax)
Pressure exerted within the cranial cavity by its components (blood, brain and cerebrospinal fluid)
ICP - intracranial pressure
The theory stating that there are 3 components in the skull. If one increases and something doesn’t, the result will be increased ICP
Monro-Kellie doctrine
What are possible etiologies for increased ICP?
Brain trauma, brain tumor, intracranial hemorrhage
Signs and symptoms of ICP
Restlessness, irritability, decrease in LOC, pupil changes (due to pressure)
Normal ICP is __ to __ mm HG
0 to 15
Any patient with a pathological intracranial condition may be at risk for ?
Increased ICP
If compression continues and the brain tissue exerts pressure on the opposite side of the brain from an injury, both pupils become ___ and _____
fixed and dilated
What is the most common method of monitoring ICP in adults?
Placing a catheter in the ventricle of the brain, in the cerebral parenchyma or in the subdural or subarachnoid space
How can you diagnose increased ICP?
CAT scan, MRI, PET, ICP monitoring, EEG
What is the highest score you can get on the Glasgow coma scale?
15
What is the lowest score you can get on the Glasgow coma scale?
3
What are the 3 sections of the Glasgow coma scale?
Eye opening, verbal response, motor response
How is the ‘eye opening’ section of the Glasgow coma scale broken down?
spontaneously - 4 points
to speech - 3 points
to pain - 2 points
none - 1 point
How is the ‘verbal response’ section of the Glasgow coma scale broken down?
orientated - 5 points confused - 4 points inappropriate - 3 points incomprehensible - 2 points none - 1 point
How is the ‘motor response’ section of the Glasgow coma scale broken down?
obeys commands - 6 points localizes to pain - 5 points withdraws from pain - 4 points flexion to pain - 3 points extension to pain - 2 points none - 1 point
Headache pain is usually behind the forehead and/or cheekbones
sinus headache
Headache pain is in and around one eye
cluster headache
Headache pain is like a band squeezing the head
tension headache
Headache pain, nausea and visual changes are typical of classic form
migraine headache
____ is the most common symptom of neurologic disorders
Headaches
What B/P meds can be given for migraines?
Nifedipine, propranolol
Vascular disturbances, stress, anxiety and emotional distress are all proposed causes of ____ headaches
cluster
These headaches can be due to premenstrual syndrome, stress or anxiety
tension headaches
Nursing care for headaches
Assessment Patient education (keep diary, record triggers, timing and symptoms, and medication teaching)
Abnormal electrical discharge within the brain due to instability of the neuron cell membrane
seizures
____ may be a symptom of epilepsy or other neurological disorders such as a tumor or brain attack
seizures
This type of seizure begins on one side of cerebral cortex
partial seizure
This type of seizure has both hemispheres of the brain involved
generalized seizure
A chronic neurologic disorder characterized by recurrent seizure activity
epilepsy
Epilepsy may be ____ or _____
acquired or idiopathic
What is acquired epilepsy?
Underlying neurological disorder such as a traumatic brain injury and anoxic events (events where the brain is left without oxygen)
What is idiopathic epilepsy?
No cause identified, and they usually begin before age 20
A sensation that warns the patient that a seizure is about to occur
-These sensations can be visual distortion, odor and sound
Aura
How many types of generalized seizures are there?
2
Seizures that are classic in children and they stare for several seconds.
Absence (petit mal)
Seizures characterized by rigidity followed by muscle contraction and relaxation with twitching movements
Tonic clonic (grand mal)
____ period follows the seizure which is a recovery period
Postictal
An ___ is the most useful test for evaluating seizures
EEG
Many anticonvulsants require periodic ___ tests to monitor serum levels as well as kidney and liver functions
blood
What are the emergency care steps during a seizure used to prevent injury?
Pad side rails Monitor airway Turn on side to prevent aspiration Suction PRN Observe and document
Stopping an anticonvulsant can result in ?
status epilepticus
30 minutes of seizure activity without a return to consciousness
Status epilepticus
What is the treatment for status epilepticus?
Ensure airway and oxygenation
Administer IV diazepam
____ ____ ____ is a major cause of death and disability in adults
traumatic brain injury
What accounts for the largest percentage of traumatic brain injuries?
motor vehicle accidents
When there has been rapid back and forth movement of the brain that causes bruises and tearing of brain tissues and vessels, but the skull is intact
Closed head injury (or nonpenetrating injury)
Refers to a break in the skull
Open head injury (or penetrating injury)
A term used to describe a moving object hitting a stationary head. An example of this type of injury is a patient who is hit in the head with a baseball bat.
Acceleration injury
Occurs when the head is in motion and strikes a stationary surface. This type of injury is seen in patients who trip and fall, hitting their head on furniture or the floor
Deceleration injury
_____ injuries may be caused by a direct blow to the head or may occur during a motor vehicle accident in which the vehicle is struck from the side
Rotational
Twisting of the brainstem can damage the _____ _____ _______, causing loss of consciousness
reticular activating system
A mild brain injury with loss of consciousness for under 5 minutes. Characterized by headache, dizziness, nausea and vomiting
Concussion
Bruising of the brain possibly accompanied by hemorrhage. Respirations, pupil reaction and motor response are affected
Contusion
Usually a venous bleed
subdural hematoma
Occur 24 hours after injury
As it increases, the patient may exhibit extremity weakness or dilation of the pupil
LOC may further deteriorate as ICP increases
Acute hematoma
Due to the chronic stretches of veins between the brain and the dura
A minor fall can cause the veins to rupture and bleed
Chronic hematoma
Usually an arterial bleed between the dura mater and the skull. Because it’s arterial, it can become large quickly
Loss of consciousness occurs and dilated pupil. Seizures or hemiparesis may occur, especially if there is no interventions
This is a fatal condition if not treated
The goal is to keep an oral airway and decrease the ICP
Epidural hematoma
If ICP remains elevated despite drainage of CSF, the next step is use of an ?
osmotic diuretic (such as mannitol (Osmitrol)
Edema or direct injury that affects the posterior portion of the pituitary gland or hypothalamus can result in adequate release of antidiuretic hormone, causing ?
diabetes insipidus
____ is displacement of brain tissue out of its normal anatomical location
Herniation
Herniation usually results in ?
brain death
Neoplastic growths of the brain or meninges
Brain tumors
Primary brain tumors rarely metastasize; however, if they do, it is to the ____
spine
____ tumors are those arising from the cells of the central nervous system
Primary
Most brain tumors are _____; that is, they have metastasized from a primary malignancy elsewhere in the body
secondary
Metastatic tumors arise from the primary cancer of:
prostate, thyroid, breast, liver and kidney
Signs and symptoms of brain tumors
Seizures Motor and sensory deficits Headaches Visual disturbances Hormone disturbances
Compression of nerve root(s) occurs
Cause can be from a known injury or unknown event
herniated disk
Signs and symptoms of herniated disk
Pain that follows the nerve path Muscle spasms Numbness or tingling of extremity Weakness of the extremity Muscle atrophy
A ____ is when dye is injected into the fluid by the spinal cord. This then outlines the spinal cord
myelogram
How do you diagnose a herniated disk?
MRI, myelogram
Treatment for herniated disk
Bed rest for 1-2 days Physical therapy, TENS unit, heat/cold, deep massage Traction - for cervical herniation Muscle relaxants NSAIDs and analgesics Epidural anesthetic injections Steroids and surgeyr
A _____ is generally done for a herniated cervical disk. This can be accomplished via an anterior or posterior approach.
Diskectomy
When the laminae is removed to relieve pressure or to assist with the removal of a herniated disk
Laminectomy
What are complications of surgery for herniated disks?
Hemorrhage
Nerve root damage
Reherniation
Herniation of another disk
How many cervical spine nerves are there?
8
What do the cervical spinal nerves do
controls the diaphragm, chest wall muscles, arms and shoulders
How many thoracic spine nerves are there?
12
What do the thoracic spinal nerves do?
controls upper body, gastrointestinal function
How many lumbar and sacral nerves are there?
5 for each
What do the lumbar and sacral nerves do?
controls lower body, bowel and bladder
What is the pathophysiology of spinal cord injuries?
Damage to nerve fibers, therefore there is interference with communication between brain and body
What are common causes of spinal cord injuries?
MVAs, sports injuries and falls
Loss of function of all extremities
quadriplegia
Weakness in function of all extremities
quadriparesis
Cervical injury of C3 or above is ____
fatal
Paralysis of the legs
paraplegia
C4 spinal cord injury
quadriplegic, paralyzed from the neck down
C5 and C6 spinal cord injury
quadriplegic with some arm and shoulder movement
C7 and C8 spinal cord injury
quadriplegic with some arm and hand movement
This is a term that can be applied to any nervous system disorder that causes degeneration, or wasting of the neurons in the nervous system
Neurodegenerative
____ is not a disease, but rather is a symptom of a number of different disorders
dementia
Characteristics of dementia
Patients have impaired intellectual functioning
They lose the ability to solve problems and maintain emotional control
They may experience personality changes and behavioral problems
Possible causes of dementia
Huntington's Parkinson's Alzheimer's multiple "mini-strokes/TIAs" Chronic alcoholism Neurological infections
What medications can cause disturbed thought processes?
Atropin Meperidine Morphine Tagamet Sleeping pills Cortisone or prednisone
What are the common meds utilized for treatment of dementia?
Aricept Cognex Exelon Reminyl Namenda
Destruction of substantia nigra in the brain responsible for dopamine production
Parkinson’s disease
Progressive, hereditary, degenerative, incurable neurological disorder
A disorder in which nerve cells in certain parts of the brain waste away
Huntington’s disease
What are the characteristics of Huntington’s?
involuntary, irregular, jerky movements
Huntington’s disease affects the ____ ____
basal ganglia
Is there a cure for Huntington’s?
No
Meds are given for Huntingtons to treat what?
Involuntary movement and behavioral outbursts
An overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities
It is a progressive disease
Alzheimer’s
____ is a mental disturbance that is temporary, and can have either a rapid or gradual onset
delirium
Which of the following problems predisposes someone to develop meningitis?
a) A sore throat for 3 days
b) A migraine headache
c) A muscle injury in the neck
d) Vision changes
a) A sore throat for 3 days
A patient with meningitis has photophobia and a severe headache. Which nursing interventions will be most helpful to relieve symptoms?
a) Administer antibiotics as ordered, and prepare the patient for lumbar puncture
b) Darken the room and administer analgesics
c) Administer acetaminophen as ordered and maintain isolation
d) Check level of consciousness with the Glasgow Coma Scale and monitor vital signs
b) Darken the room and administer analgesics
Which type of headache is most commonly associated with an aura?
a) Migraine
b) Cluster
c) Tension
d) Muscle contraction
a) Migraine
A patient makes an appointment to see a primary care practitioner for recurrent severe headaches. Which instruction by the nurse will help gather the best additional data prior to the appointment?
a) “Try relaxation and warm moist compresses for your headaches.”
b) “Call and come in the next time you have a headache so you can be examined”
c) “Keep track of how many headaches you have before you come in”
d) “Keep a diary of your headaches, recording symptoms, timing and headache triggers”
d) “Keep a diary of your headaches, recording symptoms, timing, and headache triggers
A patient who has had a generalized tonic-clonic seizure is sound asleep 30 minutes after the seizure. Meals are about to be delivered. Which nursing action is most appropriate?
a) Wake the patient because nourishment is essential following a seizure
b) Wake the patient to do a complete neurologic assessment before the meal
c) Let the patient sleep during the postictal state, and keep the meal warm
d) Do not attempt to wake the patient because of the risk of a repeat seizure
c) Let the patient sleep during the postictal state, and keep the meal warm
A patient with a history of seizures reports experiencing an aura and is concerned about an impending seizure. Place the nurse’s interventions in the correct order
a) Protect the patient from injury during the seizure
b) Document the events of the seizure
c) Help the patient lie down in a safe place
d) Turn the patient on his or her side to sleep
C, A, D, B
Which patients should be closely monitored by the nurse for symptoms of increased intracranial pressure?
a) The patient who has a history of epilepsy
b) The patient admitted with a high fever and severe headache
c) the patient in the post-anesthesia care unit following craniectomy
d) The patient with a brain tumor who is admitted for radiation therapy
e) The patient with a history of migraine headaches, admitted for orthopedic surgery
f) The patient with Alzheimer’s disease admitted with a urinary tract infection
b, c, d
Which of the following actions should the nurse take to help prevent increased intracranial pressure in a patient following a traumatic brain injury?
a) Cluster care so the patient can have long periods of rest
b) Keep the head of the bed elevated at 30 degrees
c) Suction frequently to keep the airway clear
d) Do not give anything by mouth
b) Keep the head of the bed elevated at 30 degrees
How much function can be expected in a patient with a spinal cord injury at the L2 down?
a) Quadriplegic from the neck down
b) Quadriplegic with some arm movement
c) Paraplegic with some trunk movement
d) Paraplegic, may learn to walk with a brace
d) Paraplegic, may learn to walk with a brace
A patient admitted following a T4 spinal injury. When taking morning vitals, the nurse notes that the patient appears restless and the blood pressure is elevated. Which of the following actions by the nurse is appropriate?
a) Recheck the patient’s blood pressure in 30 minutes
b) No action is necessary. This is an expected finding
c) Check for a full bladder
d) Encourage the patient to express any anxiety
c) Check for a full bladder
The symptoms of Parkinson’s disease are caused by depletion of which neurotransmitter?
a) Dopamine
b) Acetylcholine
c) Serotonin
d) Norepinephrine
a) Dopamine
Which nursing interventions are appropriate for the patient with a neurodegenerative disorder who has difficulty swallowing?
a) Show the patient how to tuck his or her chin down to the chest during swallowing
b) Provide clear to full liquids; avoid solid foods
c) Place the patient in semi-Fowler’s position for earing
d) Provide adaptive eating utensils
a) Show the patient how to tuck his or her chin down to the chest during swallowing
