Neuro (2)

Question 1

Most common cause of spinal cord injuries

Answer 1

Trauma

Question 2

Nursing issues for spinal cord injuries include

Answer 2

rehab and community care and acute admissions for event and complication

Question 3

You are in the ED. A patient is brought in due to a spinal cord injury, what are your first actions?

Answer 3

Assess respiratory pattern and airway

Question 4

Once respiratory pattern and airway is assessed, what is also important to assess?

Answer 4

mental and psychological status, check for autonomic dysreflexia

Question 5

What are s/s of Autonomic dysreflexia?

Answer 5

HTN, bradycardia, flushed face and neck, dilated pupils, nasal congestion, blurred vision, SWEATING & NAUSEA

Question 6

Meds commonly given for spinal cord injury include

Answer 6

stool softeners, H2 antagonists or antacids, low-dose anticoagulant therapy, vasopressor drug if hypotensive, corticosteroids, antispasmotic, NSAID or analgesics, and/or antidepressants

Question 7

How do you prevent and treat autonomic hyperflexia?

Answer 7

prevent fecal impaction, bladder distention, or other triggering stimuli by raise HOB immediately and remove SEQ if pt. experiencing s/s. Straight cath and remove impaction. Give HTN med and then monitor BP.

Question 8

How often should you do a neuro check on a patient with spinal cord injury?

Answer 8

Check motor and sensory level hourly or as prescribed. Sensory level may be marked on client’s skin

Question 9

Major problems associated with immobility

Answer 9

skin breakdown (pressure sores), muscle atrophy, bone density, UTIs, constipation, respiratory infection, venous stasis (ulcers), and hypercoagulability (DVT & PE)

Question 10

To prevent contractures and physical impairments, what should the nurse do?

Answer 10

reposition Q 2 h, P-ROM ( teach family too)

Question 11

What can nurses do to prevent PE/DVT?

Answer 11

low-dose anticoagulation therapy and SEQ/Stockings

Question 12

What can nurses do to prevent skin breakdown?

Answer 12

Inspect skin, lubricate bony prominences, reposition Q 2 h. apply skin barrier ointment to perineum before irritation starts. Teach family and patient how to prevent pressure ulcers

Question 13

How can we optimize bowel function/prevent constipation?

Answer 13

offer a high-calorie, high-protein, high-fiber diet as tol. Initial a bowel retraining program (use stool softeners, rectal suppositories with digital stimulation prn after meals)

Question 14

Outcomes for Impaired physical mobility; self care deficit

Answer 14

Free from complications (pressure ulcers, venous thrombosis, contractures, and fractures) and able to perform basic physical tasks, ADLs with or without assistive devices

Question 15

What meds would you expect a patient with impaired mobility to be on?

Answer 15

anticoags (long-term= Coumadin), aspirin, muscle relaxants (baclofen), stool softeners, pain meds, antibiotics

Question 16

Major care needs of immobilized patient?

Answer 16

risk of infection, discomfort, ineffective airway, hyperthermia, fluid deficits, social isolation, muscle atrophy

Question 17

What will you do if patient develops a pressure ulcer?

Answer 17

change position, maintain dressing, monitor the progress, and appropriate skin treatment

Question 18

Outcomes for impaired urinary elimination and/or constipation

Answer 18

voids > 150 ml each time, empties bladder completely, no urinary incontinence, no urinary infections (urine culture neg, voids clear & yellow urine), bowel control and ease of stool

Question 19

Interventions for impaired elimination and/or constipation

Answer 19

foley (intermittent straight cath at regular intervals), bladder training, stimulate voiding (e.g. run water, warm compress to abdomen), drink 2-2.5 L/day, valsalva maneuver, massage, rectal stimulation, manual disimpaction, stool softener

Question 20

Impaired adjustment, body image, self-esteem Outcomes

Answer 20

set realistic goals, reports feeling useful, verbalizes optimism regarding future, and identifies effective coping strategies

Question 21

Interventions for impaired adjustment of body image

Answer 21

encourage pt. to discuss perceptions and feelings, answer questions openly and honestly, refer to provider for questions regarding prognosis/recovery, and refer to spiritual advisors, psychiatric personnel, support groups for pt. and family

Question 22

What health teaching might a person with impaired immobility need?

Answer 22

teaching about mobility, activity, skin care, Ads skills, medication regimen, and sexuality education

Question 23

Degeneration of substantia negra leads to a decrease in dopamine, a neurotransmitter that helps to control voluntary movements as a neuron impulse inhibitor describes what disease?

Answer 23

Parkinson’s Dz? *remember, when you want to do DOPE you have to PARK?

Question 24

True or False, more dopamine and normal acetylcholine (Ach) leads to more excitation of neurons

Answer 24

False, Less dopamine and normal Ach = more excitation of neurons. Which can also affect SNS and norepinephrine levels (Hypotension)

Question 25

What is diminished in a patient with Parkinson’s Dz?

Answer 25

substantia nigra

Question 26

Etiology of Parkinson’s Dz

Answer 26

Genetic , environment (toxins, agriculture, meds)

Question 27

What drug constantly causes PD?

Answer 27

thorazine (chlorpromazine)

Question 28

5 Cardinal signs of Parkinson’s Dz

Answer 28

tremor (usually resting), rigidity (or muscle stiffness), akinesia (slow, sometime frozen movements), postural instability, cogwheeling (start and stop)

Question 29

Other s/s of PD?

Answer 29

micrographia, drooling, constipation, excessive sweating, greasy skin, depression, slowness of thought (bradyphrenia), cognitive problems and dementia possible later

Question 30

What med is given to a PD patient?

Answer 30

Levodopa- crosses the blood-rain barrier and presumably is converted to dopamine in the brain, which is how symptoms are relieved

Question 31

Major side effect of Levodopa

Answer 31

Dyskinesia= sudden, brief, “shock-like” muscle contraction

Question 32

Besides Levodopa, what are 2 other classes of drugs that are given to PD patients?

Answer 32

Anticholinergic drugs and dopamine agonists

Question 33

This class of drugs mimics the effect of dopamine by stimulating the same cells as dopamine

Answer 33

Dopamine agonists

Question 34

This class of drugs inhibits or blocks the physiological action on Ach at a receptor site, thus stopping tremors

Answer 34

Anticholinergic drugs

Question 35

4 surgical procedures for PD patients if drugs do not work

Answer 35

thalamotomy, pallidotomy, deep brain stimulation, and striatal grafting of dopaminergic fetal tissue? Gene therapy also an option

Question 36

7 nursing dx for PD patients

Answer 36

impaired physical mobility, risk for injury- falls, self care deficit, impaired communication, nutrition, altered thought processes- confusion, and ineffective coping r/t emotional lability

Question 37

How can you provide a safe environment for you patient?

Answer 37

remove throw rugs and excess furniture, grab bar in bathroom, handrails with all stairs, and ensure adequate lightening

Question 38

How can promote a well-balanced diet?

Answer 38

first assess client’s nutritional status and ability to feed self and swallow. Consult with dietician, speech, and occupational therapy. Provide food at proper consistency, stabilized dishes and utensils, flexible straw for drinking, small frequent meals and snacks, encourage high fiber diet with 3,000 mL of water unless contraindicated