Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AHII > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Acute autoimmune attack on peripheral nerve myelin - antibodies destroying the myelin that allows motor neuron signal - end up mostly weakness and paralysis - not interfere with pain sensation
Demyelination
Ascending paralysis (Ground to Brain) - remits same way - head to feet
Dyskinesia/paresthesias (lot weakness)
Flaccid paralysis (not interfere with pain receptors) and LOT severe pain
Resp. impairment when reaches level diaphragm - thoracic muscles that help us breathe affected first
acute/chronic
Chronic - disease process stops somewhere and not remit
3 phases - acute (1-4 weeks - active: progressing forward and have further paralysis; stays here until no further advancement); plateau (days up to two weeks - stays exactly where at; not remit or go forward); recovery (2 months to 4 yrs - get back to norm state after disease process
Aka Acute idiopathic polyneuritis

A

Patho - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Viral Infections (most common)
Campylobacter jejuni 25-50%
H. influenza
Mycoplasma pneumonia
HIV
Immunization - some studies
Immune disorders - other disorders set this off
Other stresses in body cause it

A

Triggers - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Begins in lower extremities
With Muscle weakness leading to paralysis
Diminished reflexes (Hypo-reflexia)
Ascending paralysis - up to head
Respiratory failure - start with thoracic muscles - not able breathe first; if progresses upward - will lose airway - often end up on ventilator
2-4-week peak severity
Can last Longer = chronic inflammatory demyelinating polyneuropathy/demyelination

A

CM - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis
CSF elevated protein - lumbar puncture for this elevated protein
Loss of nerve conduction
Critical care needed
Mechanical ventilation - often intubated
DVT/PE prophylaxis - not moving at all; no muscles help pump blood back up to heart - SCDs and heparin
IVIG-decrease circulating antibodies attacking myelin

A

Med treatment - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ineffective breathing pattern - #1 depending on where paralysis
Impaired gas exchange
Impaired physical mobility
Imbalanced nutrition: Inability to swallow - feed through PEG tube, NG tube, post-pyloric tube, TPN through central line
Impaired verbal communication
Anxiety - not affecting mental status; only motor neuron
Fear

A

N. diagnosis - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Maintain respiratory function - watching and assessing as not able breathe and take action quickly - must report symp and move quickly
Enhancing physical mobility - lot passive ROM - not lose muscle mass while paralyzed
Providing good adequate nutrition - watching for infection if have central line and tolerating tube feeding
Improved communication
Decreased anxiety - med/calm enviornment
Monitoring for complications - BIG ONE

A

N. interventions - Neurological disorders - Guillain-Barre Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Autoimmune disorder affecting myoneural junction. - normal Ach released from muscles - antibodies onto muscle and stopping Ach from being absorbed - muscle weakness and some paralysis
Acetylcholine receptor sites impair transmission/impaired
Decreased receptor stimulation
Muscle weakness escalates with continued activity - limited amount of Ach
Women greater than Men
75% thymus gland issue - thioma and need thymus gland removed

A

Pathophysiology - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diplopia/ptosis (80%) - Double vision and drooping eyelids
Face and throat muscle weakness - meds 45-60 min to prevent aspiration isues
Dysphonia - diff talking
Dysphagia - Increase risk choking/aspiration
Generalized weakness - motor involvement so lots pain
Pure motor; no sensory involvement

A

CM - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acetylcholinesterase inhibitor test - only used diagnose; not work as long-term therapy; marked improvement of weakness - esp in face
WARNING: likes cause cardiac arrhythmias/arrest - if do this want know antidote (atropine) available
Lab: acetylcholine antibodies
Ice test - hold over area that has muscle weakness - allows for reabsoprtion and see symptom disappear
Repetitive nerve stimulation - weaken area

A

Diagnostics - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pharmacologic therapy: Pyridostigmine; Main med; increasing concentration of available acetylcholine 4X day
Take before meals (45-60 minutes before)
Therapeutic plasma exchange - Plasmapheresis; looks like dialysis; removes offending antibodies
Surgical management
Thymectomy

A

Med surg treatment - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ineffective airway clearance - weaker not able get airway open
Interrupted family process
Fatigue
Impaired physical mobility - big deal with myasthenic crisis; could also have complete resp failure and need be intubated
Imbalanced nutrition
Impaired swallowing
Hard time with getting muscles move

A

N. diagnosis - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Conserve energy
Consistent routines
Avoid excessive activity/stress
Avoid High environmental temp - decreased Ach ability be reabsorbed
Medication prior to meals - Prevent choking/aspiration
Tape eye closed /eye drops - crisis/relapse - Prevent corneal damage

A

N. interventions - Neurological disorders - myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Loss of dopamine stores
Results in more excitatory neurotransmitters
Imbalance affects voluntary movement
Males greater than Women
15% early onset due to genetic mutation
Involuntary movements: tremors, walking, eating (high rate aspiration)

A

Patho - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Four cardinal signs
Tremor
Rigidity
Bradykinesia/akinesia - slow to no movement
Postural Instability
2 Types
Tremor dominate
Non-tremor dominate - a kinetic-rigid and postural instability
Diagnosis - need at least 2 of 4 cardinal symp

A

CM - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Unilateral (1) limb involvement
Minimal weakness
Hand and arm trembling

A

Stage 1 (Initial Stage) - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bilateral limb involvement
Masklike face – flat affect and face
Slow, shuffling gain - not able walk well - gait disturbances

A

Stage 2 (Mild Stage) - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Postural instability
Increase gait disturbances

A

Stage 3 (Moderate Disease) - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Akinesia - not moving well at all and lot rigidity
Rigidity

A

Stage 4 (Severe Disability) - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

As get into later stages - also psychiatric component - can have hallucinations

A

Stage 5 (Complete ADL Dependence) - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Good History
Four cardinal signs (need 2 of 4)
Diagnosis confirmed by a positive response to a levodopa trial - relieve manifestations of PD
PET – Rule out for any other disease process; not diagnostics for PD
Single-photon emission CT – Rule out for any other disease process; not diagnostics for PD

A

Diagnostics - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pharmacotherapy
Levodopa-most effective; reuprtake
Converts to dopamine –relieves manifestations
Surgical Treatment
Deep brain stimulation (DBS)
Electrode implanted/blocks anticholinergic release
Blocks Ach allowing more dopamine to be absorbed

A

Medical management - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Impaired physical mobility
Self-care deficits
Constipation - lack good phys mobility
Impaired nutrition - high risk of aspiration
Risk for injury
Impaired verbal communication
Knowledge deficit
Family and patient

A

N. diagnosis - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Improve mobility within safety
Enhancing self care activities - providing assistive devices, built up spoons, walkers, help them be as independent
Improved bowel elimination - up walking; stool softeners
Improved nutrition - Aspiration risk; speech therapy
Enhanced swallowing
Assistive devices
Family/Pt education - lots pt and fam edu - PT, OT, speech

A

N. interventions - Neurological disorders - Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cognitive, functional, and behavioral changes eventually destroy a person’s ability to function
Phys and mental
Subtle in onset; progress slowly
Not a normal part of aging
Non-Alzheimer dementias; Vascular dementia (multiple small infarcts in the brain that eventually cause the person not be able to func)

A

Patho - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Specific neuropathologic and biochemical changes that interfere with neurotransmission
Neurolgoic and biochem change that affect neurotransmission
Most common disease process with dementia
Early onset (familial/genetically 40-65 years)
Late onset (greater than 65 years) - MOST COMMON
Risk factors

A

Alzheimer’s - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Age
Gender
Genetics

A

risk factors - Alzheimer’s - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Independent in ADLs - Care of self on own
Denies presence of symptoms - not deny it
Forgets names; misplaces household items
Has short-term memory loss and difficulty recalling new information - STM big one; LTM good
Shows subtle changes in personality and behavior
Loses initiative and is less engaged in social relationships
Has mild impaired cognition and problems with judgment
Demonstrates decreased performance, especially when stressed - confused easily when stress
Unable to travel alone to new destinations
Often has decreased sense of smell

A

Early (Mild), or Stage I (First Symptoms up to 4 Years) - CM - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Has impairment of all cognitive functions
Demonstrates problems with handling or unable to handle money and finances
Is disoriented to time, place, and event
Is possibly depressed and/or agitated - LOT AGITATION
Is increasingly dependent in ADLs
Has visuospatial deficits: has difficulty driving and gets lost - end up ditch; nothing not where think should be
Has speech and language deficits: less talkative, decreased use of vocabulary, increasingly nonfluent speech, and eventually aphasic
Incontinent
Psychotic behaviors, such as delusions, hallucinations, and paranoia
Has episodes of wandering; trouble sleeping - lots agitation at this time

A

Middle (Moderate), or Stage II (2 to 3 Years) - CM - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Completely incapacitated; bedridden
Totally dependent in ADLs
Has loss of mobility and verbal skills
Possibly has seizures and tremors
Has agnosia

A

Late (Severe), or Stage III - CM - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clients can show manifestations from any stage at any time
Clients can have issues from any stage at anytime
Mix and Match from diff stages and can slide between stages
Health promotion - not mitigate or prevent but ward it off for slow period time

A

CM - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

History - HUGE
Physical assessment/manifestations
Psychosocial assessment
Laboratory – Rule out
Radiological – Rule out

A

Diagnostics (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Behavioral management structured environment (NEED Consistency)
Cognitive stimulation - bringing up to present
Memory training
Validation therapy (Orientation) - re-orientatin - care with this because can become agitated
Redirection
Pharmacologic therapies: Donepezil (Aricept) - not cure; only Improves symptoms

A

Med surg treatment (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Supporting Cognitive Function
Promoting Physical Safety - locked unit - often wander off
Promoting Independence in Self-Care Activities
Reducing Anxiety and Agitation - consistency and calm enviornment
Improving Communication
Providing for Socialization and Intimacy Needs - hypersexuality often experienced
Promoting Adequate Nutrition
Promoting Balanced Activity and Rest
Home, Community and Transitional to memory Care unit

A

N. management (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Calm, predictable environment; Limit environmental stimuli
Quiet, pleasant manner of speaking, clear and simple explanations
Use of good memory aids; Displayed clocks and calendars
Active participation help patients maintain cognitive, functional, and social interaction abilities for a longer period

A

Supporting Cognitive Function - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Simplify daily activities by organizing them into short, achievable steps
Lessen bulk ADLs into steps

A

Promoting Independence in Self-Care Activities - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Remove fall risks/hazards; install hand rails - slip hazards removed
Secure doors
Wandering –gentle distraction/ persuasion/redirection
Avoid restraints - lot more agitated

A

Promoting Physical Safety - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Need constant emotional support that reinforces a positive self-image
Environment should be kept familiar and noise free
Combative, agitated state: remain calm and unhurried; never force - try to redirect
Move to familiar environment; try stroking, rocking, music; Be sure pain free

A

Reducing Anxiety and Agitation - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Use of clear, easy-to-understand sentences to convey messages
Tactile stimuli (hugs or hand pats) signs of affection, concern, and security.

A

Improving Communication - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Encourage to participate in simple activities
Care of plants or a pet - good positive reinforcement

A

Providing for Socialization and Intimacy Needs - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Keep simple and calm, without confrontations
Cueing may be necessary to encourage adequate nutrition and hydration
Food is cut into small pieces to prevent choking.
Liquids may be easier to swallow if they are thickened
temperature of the foods should be checked to prevent burns

A

Promoting Adequate Nutrition - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Exhibit sleep disturbances, wandering, etc.; occur when there are unmet underlying physical or psychological needs - look for sleep disturbances
Music, warm milk, or a back rub may help the patient relax
Help Participate in exercise; discourage long periods of daytime sleeping

A

Promoting Balanced Activity and Rest - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Enormous emotional burden on family/Family provide 80% of home care
Check into this as nurse; fam caregiver strain - horrible toll on fam/pt
May cling to the hope-diagnosis is incorrect and relative will improve - forthright - progressive state
Numerous difficult decisions (stop driving, assume responsibility for finances) - taking away independence
Aggression and hostility exhibited often when misunderstood by caregivers
Neglect or abuse of the patient can occur
responsibility of nurse is to report suspected abuse, not to prove it
Family support groups, respite (relief) care, and adult day care may be available through different community resources
Nursing home placement

A

Home, Community and Transitional Care - Nursing (Dementia - Alzheimer’s) - Neurological disorders - Dementia

43
Q

Seizures: Abnormal sudden, excessive, uncontrolled electrical discharge of neurons within a section of brain
Characteristic “seizure” manifestation of this excessive neuronal discharge
Can be Genetic or Structural /metabolic condition in nature
Lab and imaging to find out what is going on
Pseudoseizures - non-electronic

A

Patho - Neurological disorders - seizure disorders

44
Q

Generalized
Tonic/Clonic
Granmal
Partial
Absence
Many subcategories
Epilepsy: two or more seizures experienced by a person - idiopathic condition

A

Classifications - Neurological disorders - seizure disorders

45
Q

History
MRI - structural probs in brain (tumors)
EEG - electrical abnormalities
Microelectrodes/Depth Electrode Placement - electrodes inside brain and see where seizure coming from and ablate track to stop seizure

A

Diagnostics - Neurological disorders - seizure disorders

46
Q

Medications
Anticonvulsants
Dilantin
Tegretol
Surgical
Removal Tumors, abscesses, cysts, or revascularization of vascular anomalies
Refractory to meds
vagal nerve stimulator (VNS)
responsive neurostimulation system (RNS)

A

Med surg treatment - Neurological disorders - seizure disorders

47
Q

Acute confusion - during and after seizure
Social isolation
Risk for ineffective airway clearance
Risk for falls
Risk for Injury
Risk for powerlessness

A

N. diagnosis - Neurological disorders - seizure disorders

48
Q

Observation and documentation of seizure - have an aura, length of seizure, presentation of seizure, post-ictal period (until back awake and functioning normally)
Side rails up and padded
Side-lying position - not until seizure done - left side preferred
Oxygen
Suction equipment - actively seizing only between teeth and cheek - can bite through easily swallow and obstruct airway
Airway
IV access
Monitor Complications-lab
Medications must be on time - missed dose and therapeutic labs fall

A

N. interventions - Neurological disorders - seizure disorders

49
Q

Provide privacy and protect patient from curious onlookers
Ease patient to floor, if possible, if standing
Protect pts head with a padding to prevent injury
Loosen constrictive clothing and remove eyeglasses - if in bed and start seizing - first thing is hang self on gown
Push aside any furniture, etc. that may injure patient during seizure
If patient is in bed, remove pillows and raise side rails
Do not attempt insert anything in the mouth during a seizure. - bite through it
If suction is available, use it if necessary, to clear secretions and while actively seizing between teeth and cheeck

A

Nursing care during a seizure

50
Q

5 min to 3-4 hrs
Make sure the airway is patent. - diff to keep airway open
Place the patient on one side to prevent aspiration. - left side best
On awakening, reorient the patient to the environment.
If the patient is confused or wandering, guide the patient gently to a bed or chair.
If the patient becomes agitated (does happen) after a seizure (postictal), stay a distance away, but close enough to prevent injury until the patient is fully aware.
Stay with until 100% back

A

Nursing care after (postictal) seizure

51
Q

Oxygen tubing
Oxygen and suction apparatus available
Loosened clothing
Two to three side rails up and padded
Bed in lowest position
Patient in side-lying position (immediate post-seizure)
Privacy provided ASAP

A

What do in seizure

52
Q

Interfere with respirations
Repeated episodes of cerebral anoxia and edema - can lead to death; irreversible and fatal brain damage

A

Prolonged seizures last more than 5 minutes or repeated seizures over course of 30 minutes - Status epilepticus: medical emergency!

53
Q

Interruption of anticonvulsant medication
Fevers - high; lower threshold
Concurrent infection

A

Risk events - Status epilepticus: medical emergency!

54
Q

Establish airway
ABCs
IV push lorazepam, diazepam - anticonvulsants not work; benzo work on CNS to depress
Rectal diazepam (if no IV)
IV phenytoin
Later to keep seizure free
ICU
Happens almost always go to ICU - put into pentobarbital coma to keep from seizing until figure how what need to do to prevent it
May need IV drip to keep seizure free

A

Emergency care - Status epilepticus: medical emergency!

55
Q

Take anticonvulsant daily as prescribed to keep the drug level constant
Never discontinue medications, even if there is no seizure activity
Keep a medication and seizure record - if possible; auras; seizure length
Notify the primary provider if unable to take medications due to illness
Have anticonvulsant medication serum levels checked regularly - too high or low - bad; need therapeutic range
Carry identification card: name medication and primary provider; med alert bracelet
Avoid seizure triggers: alcoholic beverages, stress, fever, hypoglycemia; strobe light
Take showers; never swim alone; not take baths
Avoid excessive heat - higher temp lower seizure threshold
Develop regular sleep patterns to minimize fatigue and insomnia
If recognize aura - get some place where safe

A

Nursing education: epilepsy

56
Q

Inflammation of the meninges, which cover and protect the brain and spinal cord. - inflammation of brain and SC
2 diff ways: bloodstream infection/spread directly from fracture of skull allows infection
Big deal: basilar skull fracture
Infection through blood stream or direct spread
Proliferates in CSF - heavily saturated with glucose
Can cause Inflammation and Increase ICP

A

Patho - Neurological disorders - meningitis

57
Q

Hemorrhages/vascular necrosis (Waterhouse–Friderichsen syndrome) - adrenal gland failure causing necrosis within the brain - started by meningitis
Circulatory collapse
Septic shock
Blindness/deafness - attacking optic tract
Paralysis/seizures
Hydrocephalus - water on brain

A

Comps - Neurological disorders - meningitis

58
Q

Severe headache - because of Increased ICP
Neck immobility (nuchal rigidity) - not move neck
Photophobia - any type of light bother them
Also see either + Kernig sign (lying with thigh flexed on abdomen and leg cannot be completely extended; bilateral meningeal irritation)/Brudzinski sign (neck flexed after ruling out cervical trauma - flexion knees and hip produced and when LE or one side passively flexed similar movement seen in oppositie extremity)

A

CM - Neurological disorders - meningitis

59
Q

Identify causative agent - hit by something
Lumbar Puncture
CSF culture and sensitivity
Viral or Bacterial or Fungal
What do they look like?
Blood culture and sensitivity
CT if altered LOC

A

Diagnostics - Neurological disorders - meningitis

60
Q

Broad-spectrum antibiotic - start until know causative agent
Steroids - high risk for infection and hyperglycemia
IV fluid volume expanders –shock - prob with circ collapse
Anticonvulsants-seizures
Prophylaxis treatment for those in close contact with meningitis-infected patient - college dorms
Vaccinations available

A

Med surg treatment - Neurological disorders - meningitis

61
Q

Ineffective airway clearance
Impaired comfort - neck; nuchal rigidity
Impaired mobility
Acute pain
Risk for aspiration
Risk for injury

A

N. diagnosis - Neurological disorders - meningitis

62
Q

Ensure patent airway
Pain management
Good I&O and good VS management - start consider sepsis encourage fluid intake and make sure getting good peripheral/central IV fluids
Encourage fluid intake
Close neurologic monitoring - trend if getting better/worse; worse - contacting and collab with PCP
Collaborative with physician

A

N. interventions - Neurological disorders - meningitis

63
Q

Infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious - in area)
Assisting with pain management
Assisting with getting rest in a quiet, darkened room - high risk for seizures
Treat elevated temperature: antipyretic agents and cooling blankets - high risk for seizures
Maintaining hydration either orally or peripherally
Ensuring close neurologic/respiratory monitoring
Protecting from injury secondary to seizure activity or altered LOC - increasing ICP
Monitoring daily body weight; serum electrolytes; and urine volume, and osmolality, especially if syndrome of inappropriate antidiuretic hormone (SIADH) is suspected
Preventing complications of immobility: pressure ulcers and pneumonia (SCDS and heparin)

A

Nursing - Neurological disorders - meningitis

64
Q

involves local necrotizing hemorrhage that becomes more generalized, followed by edema. - dead tissue, blood coming out, fluid accumulating on the brain
viral, bacterial, fungal: Herpes simplex most common cause in US

A

Pathophysiology - Neurological disorders - encephalitis

65
Q

Fever, headache, confusion, and hallucinations
Focal neurologic symptoms reflect areas of cerebral inflammation and necrosis - wherever affecting brain - reflected out within body

A

Clinical manifestations - Neurological disorders - encephalitis

66
Q

Diagnosis: MRI, LP (lumbar puncture), EEG
Medication
Antiviral: Acyclovir - very good for this because can cross blood-brain barrier
Complications
Atelectasis or pneumonia

A

Medical - Neurological disorders - encephalitis

67
Q

Ensure airway
Pain management
I&O
Encourage fluid intake
Close neurologic monitoring
Collaborative with physician

A

N. interventions - Neurological disorders - encephalitis

68
Q

Primary
Direct contact to the head/brain during the instant of initial injury
This what cause the injury
Secondary
Inadequate delivery of nutrients and oxygen to the cells
Swelling stops from O2 and nutrients causing further injury
Results in increased intracranial pressure (ICP)

A

Patho - Neurological disorders - traumatic brain injury

69
Q

Decreased cerebral perfusion - could cause: Cerebral edema and herniation
Impaired oxygenation and ventilation
Impaired fluid, electrolyte, and nutritional balance
HIGH Risk of posttraumatic seizures

A

Comps - Neurological disorders - traumatic brain injury

70
Q

Diagnostics
See what trending specimens tell us
Neuro exam
CT, MRI, PET - look for deformities
Medical/Surgical
Treat increased ICP - mannitol
Supportive measures - intubation, blood pressure support
Brain death - Potential donor

A

Med surg treatment - Neurological disorders - traumatic brain injury

71
Q

Ventilatory support
Airway support
Seizure prevention - anticonvulsant
Fluid and electrolyte maintenance, GOOD nutritional support
Assess for Pain and anxiety
NG tube

A

Supportive measures - Neurological disorders - traumatic brain injury

72
Q

Ineffective airway clearance and impaired gas exchange
Risk for ineffective cerebral tissue perfusion
Deficient fluid
Imbalanced nutrition: less than body requirements
Risk for injury
Risk for impaired skin integrity

A

N. diagnosis - Neurological disorders - traumatic brain injury

73
Q

ICU admission
Maintain airway
Monitor neuro function - BIG: GCS; below 8 need to intubate
Monitor fluid and electrolytes
Promote adequate nutrition
Prevent injury
Maintain body temperature - esp if hypothalamus involved
Maintain skin integrity

A

N. interventions - Neurological disorders - traumatic brain injury

74
Q

Occupies space within the skull, growing as a spherical mass or diffusely infiltrating tissue. - lesions as well
Cause:
Increased intracranial pressure
Seizure activity
Hydrocephalus - water on brain
Primary
Tumor arose from brain tissue
Secondary
Cancer metastasized from somewhere else in body
Often in lung cancer pts

A

Patho - Neurological disorders - brain tumors

75
Q

Increased intracranial pressure as seen by:
Headache
Vomiting
Visual disturbances
Seizures
Pupillary changes - incredibly late sign
Localized manifestations

A

CM - Neurological disorders - brain tumors

76
Q

Neurologic exam - trending of the data
CT scan - Structure of brain
MRI - Structure of brain
Computer assisted stereotactic biopsy - get into tumor
PET scan - tag for cancer related cells

A

Diagnostics - Neurological disorders - brain tumors

77
Q

Surgical management - crainectomy and tumor removal
Radiation therapy - intrathecal - intrabrain - omein reservoir sunk into head
Chemotherapy
Pharmacologic therapy

A

Med surg treatment - Neurological disorders - brain tumors

78
Q

Acute confusion
Fear
Decreased intracranial adaptive capacity - lead to herniation
Acute pain
Vision loss
Risk for injury

A

N. diagnosis - Neurological disorders - brain tumors

79
Q

Assess neuro status/reorient as necessary
Alleviate fear
Treat pain - lot neurological disorders not want lot pain meds because mask events
Assess for visual acuity - grow around optic chiasm and end up blind
Provide safe environment - low stimulation enviornment

A

N. interventions - Neurological disorders - brain tumors

80
Q

An injury to spinal cord, vertebral column, supporting soft tissue, or intervertebral discs caused by trauma; including:
Transient concussion
Contusion
Laceration
Compression/transection
Can lead to: Paraplegia or Tetraplegia (quadriplegia)

A

Patho - Neurological disorders - SCI

81
Q

Type and level of injury
Cervical (C5-C7) - above C5 hard time staying alive but automatically need be on ventilator
Thoracic (T12)
Lumbar (L1)
Complete vs incomplete
Complete - all stuff cut out
Incomplete - some cut out
Primary and Secondary injury
Primary - first thing that happened then as SC swells might see other injuries occur within the SC

A

CM - Neurological disorders - SCI

82
Q

Acute respiratory failure is a leading cause of death
Respiratory dysfunction related level of injury
diaphragm (C4), - on vent
intercostal (T1–T6),
Abdominal muscles (T6–T12)
C4 or above-ventilator support

A

Primary - Neurological disorders - SCI

83
Q

Hemorrhage
Ischemia
Hypovolemia
Impaired tissue perfusion
Local edema – spinal shock
Hypoesthesia
decreased sensation
Hyperesthesia
increased sensation
Where located and how affected SC

A

Secondary injury - Neurological disorders - SCI

84
Q

Critical
improper handling of patient can cause further damage
Patients in motor vehicle crash, diving/sports injury, fall, or any direct trauma to head and neck treat as SCI until such an injury is ruled out!
Immobilized on a spinal (back) board; maintained in extended position - immobilize neck; put on rotating beds without hurting neck
Head and neck maintained in a neutral position - keep neck immobilized
Not allowed to sit up
Referred to a regional spinal injury or trauma center
Extent of injury determined
Placed on a rotating specialty bed or in a cervical collar

A

Emergency management - Neurological disorders - SCI

85
Q

Neurologic exam
X-rays/CT scan/MRI/EKG
Complications
Spinal shock/Neurogenic shock
Venous Thromboembolism - not moving anything not push blood back up allowing it to coag

A

Diagnostics - Neurological disorders - SCI

86
Q

Acute
Prevent secondary Injury/complications
Pharmacologic Therapy
IV corticosteroids - stop swelling which cause further paralysis if SC invovled
Oxygen
Hypoxemia worsen injury
Feeding SC
Skeletal Fracture Reduction and Traction
Surgical Management - includes caging

A

Med surg treatment - Neurological disorders - SCI

87
Q

Ineffective breathing patterns
Ineffective airway clearance
Impaired bed and physical mobility
Risk for injury
Risk for impaired skin integrity - BIG
Impaired urinary catheter elimination - huge in autonomic hyper/dysreflexia
Constipation - huge in autonomic hyper/dysreflexia

A

N. diagnosis - Neurological disorders - SCI

88
Q

Promoting adequate breathing and airway clearance
Improving mobility
Preventing injury
Maintaining skin integrity - can cause autonomic hyper/dysreflexia
Maintaining urinary elimination - can cause autonomic hyper/dysreflexia
Improving bowel function - can cause autonomic hyper/dysreflexia
Providing comfort measures

A

N. interventions - Neurological disorders - SCI

89
Q

Acute life-threatening emergency that occurs as a result of exaggerated autonomic responses to stimuli (Cord lesions above T6) - usually above T6
Occurs only after spinal shock has resolved - shock over and another issue revealed
Severe, pounding headache with paroxysmal hypertension (230/150, profuse diaphoresis above spinal level of lesion (most often forehead), nausea, nasal congestion, and bradycardia.
Sudden increase in blood pressure may cause retinal hemorrhage, hemorrhagic stroke, myocardial infarction, or seizures
Distended bladder (the most common cause); constipation; or stimulation of the skin (tactile, pain, thermal stimuli, pressure ulcer) - main reasons see this
Must remove the offending issue

A

Recognizing autonomic dysreflexia

90
Q

Pt immediately placed in a sitting position to lower blood pressure
Rapid assessment to alleviate cause - must do this
bladder is emptied/bowel emptied/skin examined - palpate bladder; check skin and bowel
Any other stimulus: object next to skin or a draft of cold air can cause this, must be removed - take care of that - still have HTN
Measures do not relieve hypertension and causes excruciating headache,
antihypertensive medications may be prescribed; slow IV route. - bring HTN down
Once autonomic dysreflexia started even if remove offending structure, BP stay high - must use antihypertensives
Medical record labeled with risk of autonomic dysreflexia
Instructed about prevention and management measures - since could happen at home

A

Care of autonomic dysreflexia rxn

91
Q

Chronic disease characterized by demyelination and axonal nerve damage
SCI
Immune mediated
Women greater than men; 25 – 35-year-old
Risk Factors
Viruses-Epstein-Barr virus
Genetic predisposition
Types
Relapsing-remitting (85%)
Have relapse and have probs then go back to norm when done; until not then relapse and nothing happens
Primary progressive
Secondary progressive
Progressive-relapsing

A

Patho - Neurological disorders - multiple sclerosis

92
Q

Depends on location of lesions-mild to severe
Where located within SC/brain
Fatigue/Weakness
Spasticity lower extremities - baclofen to relax muscles
Bowel, Bladder, sexual dysfunction
Pain, paresthesia’s
Visual disturbances (double vision) - muscle issue or optic tract
Emotional lability/disturbances

A

CM - Neurological disorders - multiple sclerosis

93
Q

MRI
Presence of multiple plaques CNS
GOLD STANDARD
Where plaques located see neurological dysfunc
Lumbar puncture- cerebral spinal fluid (CSF) sample

A

Diagnosis - Neurological disorders - multiple sclerosis

94
Q

No cure/ONLY Delay progression
Symptom management
Medication therapy
Acute exacerbation relapse
Methylprednisolone IV
Followed by oral prednisone taper
Have use steroids to slow autoimmune
Reduce relapses
Interferons

A

Medical - Neurological disorders - multiple sclerosis

95
Q

Impaired home maintenance management - fall hazards
Ineffective coping
Impaired physical mobility - loss
Risk for injury RT sensory and visual impairment

A

Nursing Diagnosis - Neurological disorders - multiple sclerosis

96
Q

Promoting physical mobility - strengthening, adaptive devices
Preventing injury
Enhancing bladder and bowel control
Enhancing communication and managing swallowing difficulties

A

Nursing Interventions - Neurological disorders - multiple sclerosis

97
Q

Maximize neuromuscular function
Maintain independence of ADL as long as possible - adaptive measures (house one level, no step house, no slip trip hazards)
Manage disabling fatigue
Optimize psychological well-being
Adjust to chronic illness
Prevent complications of immobility - VTE or atelectasis in lungs
Reduce triggers that precipitate exacerbations
Energy conservation
Optimal nutrition
Environmental safety
Protection from heat, cold, pressure
Vision disturbances
Bladder problems – UTI common - keep clean
Constipation - increase fiber; stool softeners
Emotional support for patient and family

A

Nursing - Neurological disorders - multiple sclerosis

98
Q

Medications
Purpose, dose, route, schedule, side effects, and precautions
Steroids - increase risk infection and hyperglycemia
When to contact HCP - esp feel relapse/remission coming on
Environnemental modifications and adaptive techniques
Strategies to manage symptoms (pain, cognitive responses, dysphagia, tremors, visual disturbances).
Optimal nutritional intake; consider weight reduction if obese
Manage bowel and bladder function
Self-catheterization knowledge due to Neurogenic Bladder
Minimize immobility/spasticity
Identify sources of support - community resources; fam
Prevent complications (e.g., pressure ulcers, pneumonia, depression).

A

Pt edu - Neurological disorders - multiple sclerosis

99
Q

Exact cause unknown
Thought: Over excitation of nerve cells by neurotransmitter glutamate results in cell injury and neuronal degeneration
Motor neuron cells die in anterior horn of spinal cord and lower brainstem
Muscle fibers atrophy

A

Patho - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

100
Q

Viral infections
Autoimmune disease
Environmental exposures to toxins
Genetics-Autosomal dominant
Age 40-60
Males

A

Risk factors - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

101
Q

Cognition intact while body wastes away - brain works perfectly
Muscle weakness
Atrophy of muscles including Arms-trunk-legs
Spasticity - motor only; lot of pain
Fasciculation’s (twitching)
Lack of coordination
Resp. insufficiency/Aspiration risk
Bowel and bladder not affected

A

CM - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

102
Q

Manifestations
No clinical/labs testing available
Neuropsychological testing
MRI scan may show high signal intensity in corticospinal tracts

A

Diagnosis - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

103
Q

No cure
Riluzole, a glutamate antagonist
Baclofen - muscle spasticity
Psychosocial ramifications
Trapped, dependent on others
Explore suicidal ideation
Anti-depressives
May need counseling
Life support - decision if want be on life support

A

Med surg treatment - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

104
Q

Maintain patent airway
Prevent aspiration & respiratory infection
Facilitate communication
Provide diversional activities
Maintain optimal nutrition
Decrease risk of injury related to falls
Decrease pain secondary to muscle weakness
Support patient and family to manage disease process including grieving related to loss of motor function and ultimate death
Encourage exercise to reduce spasticity
Patient / Family coping resources
Support self-care abilities
Support nutrition - include PEG tube/enteral feeding
Adequate rest
Self-help devices
Physical therapy
Occupational therapy
Speech therapy

A

Nursing - Neurologic disorders - Amyotrophic Lateral Sclerosis (ALS)

AHII (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions