Exam 3 Neuro: Problems of the Central Nervous System: The Brain (12 questions)

Question 1

Risk factors for migraines and clusters

Answer 1

• Alcohol
• Environmental allergies
• Medication
• Intense odors, bright lights
• Fatigue, sleep deprivation
• Depression
• Emotional/physical stress, anxiety
• Menstrual cycle, oral contraceptive use
• Foods (Tyramine, caffeine, MSG, nitrites, milk products)

Question 2

Migraine symptoms

Answer 2

• Intense pain, unilateral
• Throbbing
• Worsens with movement,
• Photophobia or phonophobia

Question 3

Migraine categories

Answer 3

• Aura (classic migraine)
• No aura (common migraine)
• Atypical

Question 4

Aura migraine phases

Answer 4

• Prodrome phase
• Aura phase (Second Phase)
• Termination phase (Third phase)

Question 5

No aura migraine duration

Answer 5

4 to 72 hours

Question 6

Atypical migraines

Answer 6

• Status (longer than 72 hours)
• Migrainous infarction
• Unclassified

Question 7

3 Steps to managing a migraine

Answer 7

• Recognize migraine symptoms
• Respond and health care provider
• Relieve pain and associated symptoms

Question 8

Abortive migraine therapy: mild

Answer 8

• Acetaminophen
• NSAIDS
  Ibuprofen, naproxen
• Migraine specific OTC formulations
• Antiemetics

-Stops migraines

Question 9

Abortive migraine therapy: Severe

Answer 9

• Triptan preparations
• Ergotamine preparations
• Isometheptine combination
• Stops migraine

Question 10

Preventative migraine therapy

Answer 10

• NSAID
• Beta blocker
  Propranolol, timolol,
• Calcium channel blocker
  verapamil
• Antiepileptic drugs
  Topiramate
• Avoid triggers (risk factors)

-prevents migraines

Question 11

Complementary & Alternative therapy for migraines

Answer 11

• Yoga
• Meditation therapy
• Massage
• Exercise
• Biofeedback
• Acupuncture
• Herbal remedies

Question 12

Observation and documentations during seizures

Answer 12

• TIme
• Description (Tonic, clonic, absent)
• Whether more than one type of seizure occurs
• Sequence of seizure progression (Where it began)
• Changes in pupil size and eye deviation
• LOC
• Whether the seizures are preceded by an aura (dizziness)
• What patient does after seizure
• How long it takes for patient to return to pre-seizure status

Question 13

Acute Seizure Management

Answer 13

• Lorazepam (Ativan)
• Diazepam (Valium)
• Diastat
• IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

Question 14

Status Epilepticus

Answer 14

Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency!

Question 15

Status Epilepticus treatment

Answer 15

• Establish airway
• ABGs
• IV push lorazepam, diazepam
• Rectal diazepam
• Loading dose IV phenytoin

Question 16

Viral meningitis risk factors

Answer 16

Viral illnesses: mumps, measles, herpes, West Nile

Question 17

Fungal meningitis risk factors

Answer 17

AIDS

Question 18

Bacterial meningitis risk factors

Answer 18

• Otitis media, pneumonia, sinusitis
• Immunosuppression
• Invasive procedures
• Overcrowded living conditions
• Streptococcus pneumoniae & Neisseria meningitidis
• Haemophilus influenzae

Question 19

Viral meningitis unique characteristic

Answer 19

• There is no vaccine against it

Question 20

Meningitis symptoms

Answer 20

• Fever
• Headache
• Photophobia
• Indications of increased ICP
• Nuchal rigidity
• Positive Kernig’s, Brudzinski’s signs
• Decreased mental status
• Focal neurological deficits
• Nausea and vomiting

Question 21

Meningitis Nursing care

Answer 21

• Bacterial
  Isolation: droplet precautions
• Fever reduction
• Dark, quiet environment
• Bedrest, HOB elevated
• Seizure precautions
• Neuro checks q 2-4 hours
  Cranial nerves III, IV, VI, VII, VIII

Question 22

Meningitis Drug therapy

Answer 22

• Broad-spectrum antibiotic
• Fever-reducing agents
• Acetaminophen, ibuprofen
• Hyperosmolar agents
• Anticonvulsants
• Phenytoin
• Steroids (controversial)

Question 23

Meningitis prevention

Answer 23

Prophylaxis treatment for those in close contact with meningitis-infected patient

Question 24

Parkinson’s Disease Pathophysiology

Answer 24

• Degeneration of the substantia nigra results on decreased production of dopamine
• Overstimulation of the basal ganglia by acetylcholine

Question 25

Parkinson’s Disease Symptoms

Answer 25

• Tremor
• Muscle rigidity
• Bradykinesia
• Postural instability

Question 26

Parkinson’s Disease Medications/medication therapy

Answer 26

• Dopamine agonists
• Anticholinergics
• Catechol O-methyltransferase inhibitors
• Most effective in the first 3 to 5 years of use
• Monitor levels
• Drug holiday

Question 27

Parkinson’s Disease Nursing care

Answer 27

Collaborative

• Mobility
• Nutrition
• Psychological
• Speech therapy

Question 28

Huntington’s Disease pathophysiology

Answer 28

• Hereditary disorder
• Autosomal dominant
• Decrease in the GABA (inhibitory transmitter in the basal ganglia
• Increase in glutamate

Question 29

Huntington’s Disease Patient Teaching

Answer 29

Health teaching – include psychosocial support resources

Question 30

Huntington’s Disease medications

Answer 30

tetrabenazine

Question 31

Alzheimer’s Pathophysiology

Answer 31

• Chronic progressive
• Structural changes in brain
  Neuritic plaques, granulovascular degeneration,
  Neurofibrillary tangles

Question 32

Alzheimer’s Symptoms

Answer 32

• Gradual memory loss, short term first
• Changes in behavior & personality
• Eventual language, motor skills lost

Question 33

Alzheimer’s medication

Answer 33

• Cholinesterase inhibitors
  donepezil (Aricept)
  galantamine (Reminyl)
  rivastigmine (Exelon)
• N-methyl-D-aspartate receptor antagonist (NMDA)
  memantine (Namenda)
• Antidepressants
  SSRIs
  Avoid tricyclic antidepressants

Question 34

Alzheimer’s nursing care/safety measures

Answer 34

• Interventions and support (patient and caregiver)
• Cognitive stimulation and memory training
• Structuring the environment
• Orientation and validation therapy
• Promoting self-management
• Promoting bowel and bladder continence
• Promoting communication