Neuro - Exam 4

Question 1

cerebral angiography

Answer 1

• to visualize blood flow in brain, ID aneurysms, vascularity of tumors, inject medications to treat blood cloths & chemotherapy

Nursing care:

• to prevent aspiration –> NPO 4-6 hours before, medicate for nausea
• check dressing for bleeding and swelling
• apply ice pack
• keep extremity straight (catheter placed in groin to inject dye)

Risks: allergic rxn to dye

• thrombosis
• bleeding from entry site

Question 2

Cerebral Computed Tomography (CT) Scan

Answer 2

Noninvasive way to diagnose neurologic problems

• May or may not use contrast dye
• ID tumors, infarctions, abnormalities, monitor response to treatment, and guide biopsy needles

Nursing care:
- monitor patient for delayed allergic rxn if contrast dye was used

Question 3

Electroencephalography (EEG)

Answer 3

• ID and determine seizure activity
• detect sleep disorders and behavioral changes

Nursing care:

• instruct patient not to fast (hypoglycemia alters readings)
• avoid use of sedatives or stimulants 12-24 prior

Question 4

Magnetic Resonance Imaging (MRI) scan

Answer 4

• Discriminates soft tissue from tumor or bone
• monitor response to treatment
• guide biopsy needles

Nursing Care:

• no metal on patient
• no special follow up
• avoid gadolinium contrast in pts w/low renal function

Question 5

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) scans

Answer 5

Produce 3-D images of head to assess tumor activity

• response to treatment
• presence of dementia
• pt is injected w/deoxyglucose (which is attached to an isotope)

Nursing care:

• instruct pt to w/hold caffeine, alcohol, tobacco for 24 hour prior
• NPO for 4-12 hours prior
• radioisotope is eliminated in urine - no special precautions req’d –> increase fluid intake

Question 6

lumbar puncture

Answer 6

• insert needle between 3-4 or 4-5 lumbar vertebrae
• do not do on pt w/ICP
• pt in fetal position
• instruct not to move
• let HCP know if feel shooting pain or tingling sensation

Question 7

Classic migraine - prodromal phase (first)

Answer 7

• aura develops over a period of a few min & lasts no longer than 1 hour
• food cravings or mood changes

Question 8

Classic migraine - aura phase

Answer 8

• pain may be preceded by: visual disturbances (flashing lights) or
• variety of neurologic changes: numbness, tingling of lips or tongue, acute confusion, vertigo

Question 9

Classic migraine - headache phase

Answer 9

may last a few hours or a few days

Question 10

Classic migraine - termination phase

Answer 10

intensity of headache decreases

Question 11

Cluster headache

Answer 11

brief (30 min - 2 hour) - lasts less than 4 hours

• intense, unilateral pain
• occur in spring & fall w/o warning
• mainly men between 20-50 yrs old
• occur at same time of day for 4-12 weeks
• remission for 9 mos to year
• may pace, walk, or sit & rock

NI

• emphasize consistent sleep-wake cycle
• teach about drug options
• high flow O2 may help
• teach pt to wear sunglasses, sit facing away from window to reduce glare

Question 12

lithium - therapeutic and toxic levels

Answer 12

therapeutic - 0.6 - 1.2
toxic - > 2.0
watch Na+ levels

Question 13

digoxin - therapeutic and toxic levels

Answer 13

therapeutic - 0.5 - 2.0
toxic - > 2.0
watch K+ levels

Question 14

dilantin - therapeutic and toxic levels

Answer 14

therapeutic - 10 - 20

toxic - > 30

Question 15

Care of patient w/meningitis

Answer 15

• prioritize A, B, C’s
• take vitals and perform neurologic checks every 2-4 hours
• check Cranial Nerves
• manage pain
• perform vascular assessment and monitor for changes
• HANDWASHING!

Question 16

Drug treatment for Parkinson’s

Answer 16

1. dopamine agonists - most effective 1st 3-5 years
   - apomorphine (Apokyn)
   - pramipexole (Mirapex)
   - ropinirole (Requip)
2. Cathechol O-methyltranferases (COMTs) inhibitors - block the enzyme that inactivates dopamine (prolonging the action of levodopa)
   - entacapone (Comtan) - often used in combo w/levodopa
   - levodopa+carbidopa+entacapone (Stalevo)
3. MAO-B - used in pts w/early or mild symptoms
   - selegiine (Deprenyl)
   - rasagiline mesylate (Azilect)
   [pts need to avoid food w/tyramine - cheese, aged, smoked or cured foods and sausage]
4. Antiviral
   - amantadine (Symmetrel0
5. Cholinesterase inhibitor -
   rivastigmine (Exelon)

Pts need to take drug holidays - up to 10 days to reduce drug tolerance

Question 17

prosopagnosia

Answer 17

• inability to recognize oneself and other familiar faces
• encourage family to provide picture of family members and close friends
• use reminiscence therapy while assisting pt w/ADLs

Question 18

MS drug - natalizumab (Tysabri)

Answer 18

• IV infusion
• monitor for anaphylactic shock/allergy
• high risk for progressive multifocal leukoencephalopathy (PML) - opportunistic viral infection that leads to death or severe disability
• damages hepatic cells

NI - monitor liver enzymes
- teach pts to have frequent lab tests to assess for changes

Question 19

MS drug - fingolimod (Gilenya)

Answer 19

• oral immunomodulator - inhibits immune cells
• drug can cause bradycardia (pt must monitor pulse)
• can cause facial flushing
• GI disturbances

Question 20

care for craniotomy patient - supratentorial surgery

Answer 20

• elevate HOB 30 degrees (or as tolerated) to help promote venous drainage from hear
• avoid extreme hip or neck flexion
• maintain head in midline/neutral position to prevent increased ICP
• turn to prevent pressure ulcers and pneumonia

Question 21

care for craniotomy patient - infratentorial surgery

Answer 21

• keep flat and side-lying position (prevents pressure on neck-area incision site)
• alternate sides Q2H for 24-48 hours
• NPO for 24 hours to reduce edema around medulla and lower cranial nerves = vomiting and aspiration

Question 22

how much drainage OK for craniotomy patient?

Answer 22

30-50 ml Q8H

- more than that, report immediately