neurologic disorder 2

Question 1

Inflammation of brain tissue caused by virus

Answer 1

Encephalitis

Question 2

Signs and symptoms Encephalitis

Answer 2

Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and restlessness commonly seen
Comatose or exhibit aphasia, hemiparesis, facial weakness, and other alterations in motor activity

Question 3

Medical treatment Encephalitis

Answer 3

Enhance patient comfort and increase strength

Because seizure activity is a potential problem, take appropriate safety precautions

Question 4

Nursing Care

Encephalitis

Answer 4

The nursing plan of care parallels that of the patient with meningitis

Question 5

Although specific cause unknown, it is believed to be an autoimmune response to a viral infection
Patients often report some recent viral infection or vaccination

Answer 5

Guillain-Barré Syndrome

Question 6

Initial phase s/s Guillain-Barré Syndrome

Answer 6

Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper extremities
Visual and hearing disturbances, difficulty chewing, and lack of facial expression
Mild paresthesias or anesthesia in feet and hands in a glove or stocking distribution pattern
Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention

Question 7

Plateau phase s/s Guillain-Barré Syndrome

Answer 7

Remains essentially unchanged

No further neurologic deterioration, but no improvement either

Question 8

Recovery phase s/s Guillain-Barré Syndrome

Answer 8

Remyelinization; muscle strength returns in a proximal-to-distal pattern (head to toes

Question 9

medical diagnosis Guillain-Barré Syndrome

Answer 9

Characteristic onset and pattern of ascending motor involvement
Elevated protein level in the CSF
Nerve conduction velocity studies reveal slowed conduction speed in the involved nerves

Question 10

medical treatment Guillain-Barré Syndrome

Answer 10

Preserve vital function, particularly respiration
Respiratory status is closely monitored and mechanical ventilation initiated if vital capacity falls to 15 mL/kg of body weight
Massive doses of corticosteroids prescribed to suppress the inflammatory process
Plasmapheresis

Question 11

assessment of Guillain-Barré Syndrome

Answer 11

Health history describes the progression of symptoms
Note fears, coping strategies, and sources of support
Physical examination focuses on cranial nerve, motor, respiratory, and cardiovascular function

Question 12

Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement

Answer 12

Parkinson’s Syndrome

Question 13

Parkinson’s Syndrome s/s

Answer 13

Tremor, rigidity, and bradykinesia
Loss of dexterity and power in affected limbs, aching, monotone voice, handwriting changes, drooling, lack of facial expression, rhythmic head nodding, reduced blinking, and slumped posture
Depression common; dementia may develop

Question 14

Medical diagnosis Parkinson’s Syndrome

Answer 14

From health history and physical examination

MRI to rule out other causes of the symptoms

Question 15

Medical treatment Parkinson’s Syndrome

Answer 15

Control symptoms: physical therapy and drug therapy
Massage, heat, exercise, and gait retraining
Dopamine receptor agonists pramipexole (Mirapex) or ropinirole (Requip); L-dopa (L-dihydroxyphenylalanine); carbidopa/levodopa (Sinemet); anticholinergic drugs such as trihexyphenidyl (Artane) and benztropine (Cogentin)

Question 16

assessment Parkinson’s Syndrome

Answer 16

Weakness, fatigue, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements
Note lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination

Question 17

Chronic, progressive degenerative disease
An autoimmune response that attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS

Answer 17

Multiple Sclerosis

Question 18

Chronic, progressive MS

Answer 18

progresses steadily

Question 19

Exacerbating-remitting MS

Answer 19

exacerbations and remissions

Question 20

Relapsing-progressive MS

Answer 20

less stable periods than exacerbating-remitting

Question 21

Stable MS

Answer 21

stable; no active disease for a year

Question 22

MS related to

Answer 22

Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated

Question 23

s/s of MS

Answer 23

Fatigue, weakness, and tingling in one or more extremities; visual disturbances; problems with coordination; bowel and bladder dysfunction; spasticity; and depression

Question 24

Medical diagnosis

for MS

Answer 24

Based on the physical examination and history of cyclic remission-exacerbation periods
Magnetic resonance imaging of the brain and spinal cord may reveal plaques characteristic of MS

Question 25

Medical treatment for MS

Answer 25

Corticosteroids (ACTH, prednisone, methylprednisolone)
Interferon  1b (Betaseron) and interferon 1a (Avonex)
Glatiramer acetate (Copaxone)
Immunosuppressants: mitoxantrone (Novantrone)
Amantadine (Symmetrel)
Urinary retention treated with cholinergics, such as bethanechol (Urecholine) or neostigmine (Prostigmine

Question 26

assessment for MS

Answer 26

Onset and progression of symptoms, especially those that affect mobility, vision, eating, and elimination
Range of motion and strength, gait abnormalities, tremors, and muscle spasms

Question 27

a degenerative neurologic disease
Virus suspected, but exact cause unknown
Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms

Answer 27

Amyotrophic Lateral Sclerosis (ALS)

Also known as Lou Gehrig’s disease

Question 28

s/s Amyotrophic Lateral Sclerosis (ALS)

Answer 28

Weakness of voluntary muscles of the upper extremities, particularly the hands
Difficulty swallowing and speaking
Eventually, respirations shallow; difficulty clearing airway of pulmonary secretions
Death results from aspiration, respiratory infection, or respiratory failure

Question 29

Medical diagnosis Amyotrophic Lateral Sclerosis (ALS)

Answer 29

History and physical examination findings

Electromyography

Question 30

Medical treatment Amyotrophic Lateral Sclerosis (ALS)

Answer 30

Because no known cure or treatment, therapy is supportive; focuses on preventing complications and maintaining maximum function

Question 31

Nursing Assessment Amyotrophic Lateral Sclerosis (ALS)

Answer 31

Dyspnea, dysphagia, muscle cramps, weakness, twitching, joint stiffness, muscle atrophy, abnormal reflexes and gait, and paralysis

Question 32

Insufficient receptor sites at the junction of the motor nerve with the muscle
With repeated stimulation, muscle becomes exhausted; eventually unable to contract at all
If respiratory muscles involved, death from respiratory insufficiency or arrest possible
May have an autoimmune basis

Answer 32

Myasthenia Gravis

Question 33

s/s Myasthenia Gravis

Answer 33

Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking
Partial improvements of strength with rest
Dramatic improvement with the use of anticholinesterase drugs
Ptosis and diplopia commonly seen

Question 34

Medical diagnosis Myasthenia Gravis

Answer 34

Administering edrophonium (Tensilon)
Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes

Question 35

Medical treatment Myasthenia Gravis

Answer 35

Anticholinesterase drugs
Neostigmine and pyridostigmine (Mestinon) 
Corticosteroids
Cytotoxic therapies
Thymectomy
Plasmaphere

Question 36

assessment of Myasthenia Gravis

Answer 36

Health history describes the onset of symptoms: muscle weakness, diplopia, dysphagia, slurred speech, breathing difficulties, and loss of balance