Med Surg - Exam 3 - Ch 59 (Chronic Neurologic Problems) COPY Flashcards
A 50-year-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also resports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has
a. cluster headaches.
b. tension headaches.
c. migraine headaches.
d. medication overuse headaches.
a. cluster headaches.
Cluster headaches involve repeated headaches that can occur for weeks to months, followed by periods of remission. The pain of cluster headache is sharp and stabbing; the intense pain lasts a few minutes to 3 hours. Cluster headaches can occur every other day and as often as eight times a day. The clusters occur with regularity, usually occurring at the same time each day and during the same seasons of the year. Typically, a cluster lasts 2 weeks to 3 months, and the patient then goes into remission for months to years. The pain usually is located around the eye and radiates to the temple, forehead, cheek, nose, or gums. Other manifestations may include swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.
A 65-year-old woman was just diagnosed with Parkinson’s disease. The priority nursing intervention is
a. searching the Internet for educational videos.
b. evaluating the home for environmental safety.
c. promoting physical exercise and a well-balanced diet.
d. designing an exercise program to strengthen and stretch specific muscles.
c. promoting physical exercise and a well-balanced diet.
Promotion of physical exercise and a well-balanced diet are major concerns of nursing care for patients with Parkinson’s disease.
The nurse finds that an 87-year-old woman with Alzheimer’s disease is continually rubbing, flexing, and kicking out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to
a. ask the physician for a daytime sedative for the patient.
b. request soft restraints to prevent her from falling out of bed.
c. ask the physician for a nighttime sleep medication for the patient.
d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.
d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.
The severity of sensory symptoms of restless legs syndrome (RLS) ranges from infrequent, minor discomfort (paresthesias, including numbness, tingling, and “pins and needles” sensation) to severe pain. The discomfort occurs when the patient is sedentary and is most common in the evening or at night. The pain at night can disrupt sleep and is often relieved by physical activity, such as walking, stretching, rocking, or kicking. In the most severe cases, patients sleep only a few hours at night, which results in daytime fatigue and disruption of the daily routine. The motor abnormalities associated with RLS consist of voluntary restlessness and stereotyped, periodic, involuntary movements. The involuntary movements usually occur during sleep. Symptoms are aggravated by fatigue.
Social effects of a chronic neurologic disease include (select all that apply)
a. divorce.
b. job loss.
c. depression.
d. role changes.
e. loss of self-esteem.
All of the above.
Social problems related to chronic neurologic disease may include changes in roles and relationships (e.g., divorce, job loss, role changes); other psychologic problems (e.g., depression, loss of self-esteem) also may have social effects.
The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis. Which statement would be appropriate to include in the teaching?
a. “ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication.”
b. “Even though the symptoms you are experiencing are severe, most people recover with treatment.”
c. “You need to consider advance directives now, since you will lose cognitive function as the disease progresses.”
d. “This is a progressing disease that eventually results in a permanent paralysis, though you will not lose any cognitive function.”
d. “This is a progressing disease that eventually results in a permanent paralysis, though you will not lose any cognitive function.”
The disease results in destruction of the motor neurons in the brainstem and spinal cord, causing gradual paralysis. Cognitive function is maintained. Because there is no cure for amyotrophic lateral sclerosis (ALS), collaborative care is palliative and based on symptom relief. Death usually occurs within 3-6 years after diagnosis.
A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. The nurse immediately assesses the patient for
a. an aura or focal seizure.
b. nystagmus or confusion.
c. abdominal pain or cramping.
d. irregular pulse or palpitations.
b. nystagmus or confusion.
Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.
Which characteristic of a patient’s recent seizure is consistent with a focal seizure?
a. The patient lost consciousness during the seizure.
b. The seizure involved lip smacking and repetitive movements.
c. The patient fell to the ground and became stiff for 20 seconds.
d. The etiology of the seizure involved both sides of the patient’s brain.
b. The seizure involved lip smacking and repetitive movements.
The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)?
a. Vigilant infection control and adherence to standard precautions
b. Careful monitoring of neurologic assessment and frequent reorientation
c. Maintenance of a calorie count and hourly assessment of intake and output
d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension
a. Vigilant infection control and adherence to standard precautions
Infection control is a priority in the care of patients with MS, since infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.
A male patient with a diagnosis of Parkinson’s disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take in order to promote adequate nutrition for this patient?
a. Provide multivitamins with each meal.
b. Provide a diet that is low in complex carbohydrates and high in protein.
c. Provide small, frequent meals throughout the day that are easy to chew and swallow.
d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.
c. Provide small, frequent meals throughout the day that are easy to chew and swallow.
Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or pureed diet, and a low carbohydrate diet is not indicated.
Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)?
a. Acute confusion
b. Bowel incontinence
c. Activity intolerance
d. Disturbed sleep pattern
c. Activity intolerance
The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.
A female patient complains of a throbbing headache. When her history is obtained, the nurse discovers that the patient has had this type of headache before and experienced photophobia before the headache occurred. The nurse should know that what is probably the cause of this patient’s headache?
a. Polycythemia vera
b. A cluster headache
c. A migraine headache
d. A hemorrhagic stroke
c. A migraine headache
Although a headache may occur with any of these options, a migraine headache is the only one that has a throbbing headache with an aura (the photophobia). Headache from polycythemia vera is from erythrocytosis. The cluster headache pain is sharp and stabbing, and the headache with a hemorrhagic stroke has a sudden onset and is not recurrent.
The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure?
a. IV dextrose solution
b. IV diazepam (Valium)
c. IV phenytoin (Dilantin)
d. Oral carbamazepine (Tegretol)
a. IV dextrose solution
This patient’s seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes such as head trauma, drugs, and infections.
A 50-year-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS?
a. Reduce fat intake.
b. Reduce the risk of aspiration.
c. Decrease injury related to falls.
d. Decrease pain secondary to muscle weakness.
b. Reduce the risk of aspiration.
Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.
When establishing a diagnosis of MS, the nurse should teach the patient about what diagnostic studies (select all that apply)?
a. EEG
b. CT scan
c. Carotid duplex scan
d. Evoked response testing
e. Cerebrospinal fluid analysis
b. CT scan
d. Evoked response testing
e. Cerebrospinal fluid analysis
There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI along with history and physical examination are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS.
A 48-year-old man was just diagnosed with Huntington’s disease. His 20-year-old son is upset about his father’s diagnosis. How can the nurse best help this young man?
a. Provide emotional and psychologic support.
b. Encourage him to get diagnostic genetic testing done.
c. Tell him the cognitive deterioration will be treated with counseling.
d. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).
a. Provide emotional and psychologic support.
The patient’s son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing for himself but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined depending on his father’s needs.
Which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache?
a. Cluster
b. Migraine
c. Frontal-type
d. Tension-type
b. Migraine
Migraine headaches are frequently unilateral and usually throbbing. They may be preceded by a prodrome and frequently there is a family history. Cluster headaches are also unilateral with severe bone-crushing pain but there is no prodrome or family history. Frontal-type headache is not a functional type of headache. Tension-type headache are bilateral with constant, squeezing tightness without prodrome or family history.
A patient is diagnosed with cluster headaches. The nurse knows that which characteristics are associated with this type of headache (select all that apply)?
a. Family history
b. Alcohol is the only dietary trigger
c. Abrupt onset lasting 5 to 180 minutes
d. Severe, sharp, penetrating head pain
e. Bilateral pressure or tightness sensation
f. May be accompanied by unilateral ptosis or lacrimation
b. Alcohol is the only dietary trigger
c. Abrupt onset lasting 5 to 180 minutes
d. Severe, sharp, penetrating head pain
f. May be accompanied by unilateral ptosis or lacrimation
Cluster headaches have only alcohol as a dietary trigger and have an abrupt onset lasting 5 minutes to 3 hours with severe, sharp, penetrating pain. Cluster headaches may be accompanied by unilateral ptosis, lacrimation, rhinitis, facial flushing or pallor and commonly recur several times each day for several weeks, with months or years between clustered attacks. Family history and nausea, vomiting, or irritability may be seen with migraine headaches. Bilateral pressure occurring between migraine headaches and intermittent occurrence over long periods of time are characteristics of tension-type headaches.
What is the most important method of diagnosing functional headaches?
a. CT scan
b. Electromyography (EMG)
c. Cerebral blood flow studies
d. Thorough history of the headache
d. Thorough history of the headache
The primary way to diagnose and differentiate between headaches is with a careful history of the headaches, requiring assessment of specific details related to the headache. Electromyelography (EMG) may reveal contraction of the neck, scalp, or facial muscles in tension-type headaches but this is not seen in all patients. CT scans and cerebral angiography are used to rule out organic causes of the headaches.
What drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches?
a. B-Adrenergic blockers such as propanolol (Inderal)
b. Serotonin antagonists such as methysergide (Sansert)
c. Tricyclic antidepressants such as amitriptyline (Elavil)
d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)
d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)
Triptans (sumatriptan [Imitrex]) affect selected serotonin receptors that decrease neurogenic inflammation of the cerebral blood vessels and produce vasoconstriction. Both migraine headaches and cluster headaches appear to be related to vasodilation are useful in treatment of migraine and cluster headaches. Methysergide blocks serotonin receptors in the central and peripheral nervous systems and is used for prevention of migraine and cluster headaches. B-adrenergic blockers and tricyclic antidepressants are used prophylactically for migraine headaches but are not effective for cluster headaches.
What is a nursing intervention that is appropriate for the patient with a nursing diagnosis of anxiety related to lack of knowledge of the etiology and treatment of headache?
a. Help the patient to examine lifestyle patterns and precipitating factors.
b. Administer medications as ordered to relieve pain and promote relaxation.
c. Provide a quiet, dimly lit environment to reduce stimuli that increase muscle tension and anxiety.
d. Support the patient’s use of counseling or psychotherapy to enhance conflict resolution and stress reduction.
a. Help the patient to examine lifestyle patterns and precipitating factors.
When the anxiety is related to a lack of knowledge about the etiology and treatment of a headache, helping the patient to identify stressful lifestyle patterns and other precipitating factors and ways of avoiding them are appropriate nursing interventions for the anxiety. Interventions that teach alternative therapies to supplements drug therapy also give the patient some control over pain and are appropriate teaching regarding treatment of the headache. The other interventions may help to reduce anxiety generally but they do not address the etiologic factor of the anxiety.
The nurse is preparing to admit a newly diagnosed patient experiencing tonic-clonic seizures. What could the nurse delegate to unlicensed assistive personnel (UAP)?
a. Complete the admission assessment.
b. Explain the call system to the patient.
c. Obtain the suction equipment from the supply cabinet.
d. Place a padded tongue blade on the wall above the patient’s bed.
c. Obtain the suction equipment from the supply cabinet.
The unlicensed assistive personnel (UAP) is able to obtain equipment from the supply cabinet or department. The RN may need to provide a list of necessary equipment and should set up the equipment and ensure proper functioning. The RN is responsible for the initial history and assessment as well as teaching the patient about the room’s call system. Padded tongue blades are no longer used and no effort should be made to place anything in the patient’s mouth during a seizure.
How do generalized seizures differ from focal seizures?
a. Focal seizures are confined to one side of the brain and remain focal in nature.
b. Generalized seizures result in loss of consciousness whereas focal seizures do not.
c. Generalized seizures result in temporary residual deficits during the postictal phase.
d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.
d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.
Generalized seizures have bilateral synchronous epileptic discharge affecting the entire brain at onset of the seizure. Loss of consciousness is also characteristic but many focal seizures also include an altered consciousness. Focal seizures begin in one side of the brain but may spread to involve the entire brain. Focal seizures that start with a local focus and spread to the entire brain, causing a secondary generalized seizure, are associated with a transient residual neurologic deficit postictally known as Todd’s paralysis.
Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that lasts for a few seconds?
a. Atonic
b. Simple focal
c. Typical absence
d. Atypical absence
c. Typical absence
The typical absence seizure is also known as petit mal and the child has staring spells that last for a few seconds. Atonic seizures occur when the patient falls from loss of muscle tone accompanied by brief unconsciousness. Simple focal seizures have focal motor, sensory, or autonomic symptoms related to the area of the brain involved without loss of consciousness. Staring spells in atypical absence seizures last longer than those in typical absence seizures and are accompanied by peculiar behavior during the seizure or confusion after the seizure.
The patient is diagnosed with complex focal seizures. Which characteristics are related to complex focal seizures (select all that apply)?
a. Formerly known as grand mal seizure
b. Often accompanied by incontinence or tongue or cheek biting
c. Psychomotor seizures with repetitive behaviors and lip smacking
d. Altered memory, sexual sensations, and distortions of visual or auditory sensations
e. Loss of consciousness and stiffening of the body with subsequent jerking of extremities
f. Often involves behavioral, emotional, and cognitive functions with altered consciousness
c. Psychomotor seizures with repetitive behaviors and lip smacking
d. Altered memory, sexual sensations, and distortions of visual or auditory sensations
f. Often involves behavioral, emotional, and cognitive functions with altered consciousness
Complex focal seizures are psychomotor seizures with automatisms such as lip smacking. They cause altered consciousness or loss of consciousness producing a dreamlike state and may involve behavioral, emotional, or cognitive experiences without memory of what was done during the seizure. In generalized tonic-clonic seizures (previously known as grand mal seizures) there is a loss of consciousness and stiffening of the body with subsequent jerking of extremities. Incontinence or tongue or cheek biting may also occur.
Which type of seizure is most likely to cause death for the patient?
a. Subclinical seizures
b. Myoclonic seizures
c. Psychogenic seizures
d. Tonic-clonic status epilepticus
d. Tonic-clonic status epilepticus
Tonic-clonic status epilepticus is most dangerous because the continuous seizing can cause respiratory insufficiency, hypoxemia, cardiac dysrhythmia, hyperthermia, and systemic acidosis, which can all be fatal. Subclinical seizures may occur in a patient who is sedated, so there is no physical movement. Myoclonic seizures may occur in clusters and have a sudden, excessive jerk of the body that may hurl the person to the ground. Psychogenic seizures are psychiatric in origin and diagnosed with video-electroencephalography (EEG) monitoring. They occur in patients with a history of emotional abuse or a specific traumatic episode.
A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse?
a. “So many factors can cause epilepsy that it is impossible to say what caused your seizure.”
b. “Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?”
c. “In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity.”
d. “Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges.”
c. “In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity.”
A seizure is a paroxysmal, uncontrolled discharge of neurons in the brain, which interrupts normal function, but the factor that causes the abnormal firing is not clear. Seizures may be precipitated by many factors and although scar tissue may make the brain neurons more likely to fire, it is not the usual cause of seizures. Epilepsy is established only by a pattern of spontaneous, recurring seizures.
A patient with a seizure disorder is being evaluated for surgical treatment of seizures. The nurse recognizes that what is one of the requirements for surgical treatment?
a. Identification of scar tissue that is able to be removed
b. An adequate trial of drug therapy that had unsatisfactory results
c. Development of toxic syndromes from long-term use of antiseizure drugs
d. The presence of symptoms of cerebral degeneration from repeated seizures
b. An adequate trial of drug therapy that had unsatisfactory results
Most patients with seizures disorders maintain seizure control with medications but if surgery is considered, three requirements must be met: the diagnosis of epilepsy must be confirmed, there must have been an adequate trial with drug therapy without satisfactory results, and the electroclinical syndrome must be defined. The focal point must be localized but the presence of scar tissue is not required.
The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and measure for toxicity.
a. A daily seizure log
b. Urine testing for drug levels
c. Blood testing for drug levels
d. Monthly electroencephalography (EEG)
c. Blood testing for drug levels
Serum levels of antiseizure drugs are monitored regularly to maintain therapeutic levels of the drug, above which patients are likely to experience toxic effects and below which seizures are likely to occur. Many newer drugs do not require drug level monitoring because of large therapeutic ranges. A daily seizure log and urine testing for drug levels will not measure compliance or monitor for toxicity. EEGs have limited value in diagnosis of seizures and even less value in monitoring seizure control.
When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize?
a. The patient should increase the dosage of the medication if stress is increased.
b. Most over-the-counter and prescription drugs are safe to take with antiseizure drugs.
c. Stopping the medication abruptly may increase the intensity and frequency of seizures.
d. If gingival hypertrophy occurs, the drug should be stopped and the health care provider notified.
c. Stopping the medication abruptly may increase the intensity and frequency of seizures.
If antiseizure drugs are discontinued abruptly, seizures can be precipitated. Missed doses should be made up if the omission is remembered within 24 hours and patients should not adjust medications without professional guidance because this can also increase seizure frequency and may cause status epilepticus. Antiseizure drugs have numerous interactions with other drugs and the use of other medications should be evaluated by health professionals. If side effects occur, the physician should be notified and drug regimens evaluated.
The nurse finds a patient in bed having a tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)?
a. Loosen restrictive clothing.
b. Turn the patient to the side.
c. Protect the patient’s head from injury.
d. Place a padded tongue blade between the patient’s teeth.
e. Restrain the patient’s extremities to prevent soft tissue and bone injury.
a. Loosen restrictive clothing.
b. Turn the patient to the side.
c. Protect the patient’s head from injury.
The focus is on maintaining a patent airway and preventing patient injury. The nurse should not place objects in the patient’s mouth or restrain the patient.
Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide?
a. Suction the patient before allowing him to rest.
b. Allow the patient to sleep as long as he feels sleepy.
c. Stimulate the patient to increase his level of consciousness.
d. Check the patient’s level of consciousness every 15 minutes for an hour.
b. Allow the patient to sleep as long as he feels sleepy.
In the postictal phase of generalized tonic-clonic seizures, patients are usually very tired and may sleep for several hours and the nurse should allow the patient to sleep for as long as necessary. Suctioning is performed only if needed and decreased level of consciousness is not a problem postictally unless a head injury has occurred during the seizure.
During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient?
a. Managing the complicated drug regimen of seizure control
b. Coping with the effects of negative social attitudes toward epilepsy
c. Adjusting to the very restricted lifestyle required by a diagnosis of epilepsy
d. Learning to minimize the effect of the condition in order to obtain employment
b. Coping with the effects of negative social attitudes toward epilepsy
One of the most common complications of a seizure disorder is the effect it has on the patient’s lifestyle. This is because of the social stigma attached to seizures, which causes patients to hide their diagnosis and to prefer not to be identified as having epilepsy. Medication regimens usually require only once-or twice-daily dosing and the major restrictions of the lifestyle usually involve driving and high-risk environments. Job discrimination against the handicapped is prevented by federal and state laws and patients only need to identify their disease in case of medical emergencies.
A patient at the clinic for a routine health examination mentions that she is exhausted because her legs bother her so much at night that she cannot sleep. The nurse questions the patient further about her leg symptoms with what knowledge about restless legs syndrome?
a. The condition can be readily diagnosed with EMG.
b. Other more serious nervous system dysfunctions may be present.
c. Dopaminergic agents are often effective in managing the symptoms.
d. Symptoms can be controlled by vigorous exercise of the legs during the day.
c. Dopaminergic agents are often effective in managing the symptoms.
Restless legs syndrome that is not related to other pathologic processes, such as diabetes mellitus or rheumatic disorders, may be caused by a dysfunction in the basal ganglia circuits that use the neurotransmitter dopamine, which controls movements. Dopamine precursors and dopamine agonists, such as those used for parkinsonism, are effective in managing sensory and motor symptoms. Polysomnography studies during sleep are the only tests that have diagnostic value and although exercise should be encouraged, excessive leg exercise does not have an effect on the symptoms.
Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and y-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system?
a. Myasthenia gravis
b. Parkinson’s disease
c. Huntington’s disease
d. Amyotrophic lateral sclerosis (ALS)
c. Huntington’s disease
Huntington’s disease (HD) involves deficiency of acetylcholine and y-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system that causes the opposite symptoms of parkinsonism. Myasthenia gravis involves autoimmune antibody destruction of cholinergic receptors at the neuromuscular junction. Amyotrophic lateral sclerosis (ALS) involves degeneration of motor neurons in the brainstem and spinal cord.
A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. Which is the best response by the nurse?
a. “You will have either periods of attacks and remissions or progression of nurse damage over time.”
b. “You need to plan for a continuous loss of movement, sensory functions, and mental capabilities.”
c. “You will most likely have a steady course of chronic progressive nerve damage that will change your personality.”
d. “It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years.”
a. “You will have either periods of attacks and remissions or progression of nurse damage over time.”
Most patients with multiple sclerosis (MS) have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration and some may experience only occasional and mild symptoms for several years after onset.
During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find?
a. Tremors, dysphasia, and ptosis
b. Bowel and bladder incontinence and loss of memory
c. Motor impairment, visual disturbances, and parathesias
d. Excessive involuntary movements, hearing loss, and ataxia
c. Motor impairment, visual disturbances, and parathesias
Specific neurologic dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system. Motor, sensory, cerebellar, and emotional dysfunctions, including parasthesias as well as patchy blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue, are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary movements and tremors are not seen in MS.
