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NUB 350 > Neurological - Module 10 > Flashcards

Neurological - Module 10 Flashcards

1
Q

Spinal Nerves

A 
Cervical - 8 pairs
Thoracic - 12 pairs
Lumbar - 5 pairs
Sacral - 5 pairs
Coccyx - 1 pair
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2
Q

Cranial Nerves

A 
I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Abducens
VII - Facial
VII - Acoustic or Vestibulocochlear
IX - Glossopharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal

“Some Say Money Matters But My Brother Says Big Brains Matter Most”

“Old Opie Occasionally Tries Trigonometry And Feels Very Gloomy, Vague and Hypoactive”

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3
Q

Risk factors of Brain Attack

A
  • Hypertension
  • CAD
  • CHF
  • A-fib
  • Hyperlipidemia
  • Obesity
  • Sickle Cell
  • Diabetes
  • BCP
  • Smoking
  • Cocaine abuse
  • ETOH abuse
  • High Hct
  • Sedentary lifestyle
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4
Q

General clinical manifestations of Brain Attack

A
  • numbness, one sided weakness
  • mental changes
  • aphasia, dysphagia
  • visual changes
  • ataxia, dizziness
  • severe headache
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5
Q

Left sided CVA

A
  • Right visual defect
  • Right side paralysis
  • Intellectual changes - memory
  • Slow, cautious behavior

Left brain is more analytical, controlling math, logic and language

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6
Q

Right sided CVA

A
  • Left visual defects
  • left sided paralysis
  • spatial-perceptual changes
  • decrease in attention
  • impulsive behavior
  • unaware of deficits
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7
Q

Fast treatment for CVA

A
  • t-PA
  • Heparin
  • Nursing measures:
  • – raise HOB
  • – Patent airway
  • – Vital signs
  • – Neuro checks

Long-term nursing measures:

  • correct postioning
  • exercise
  • mobility
  • ROM
  • nutrition/vision
  • be patient
  • skin care
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8
Q

Patient teaching for CVA

A

Promotion of self-care

  • wide-grip utensils
  • plate guards
  • velcro

Environmental safety

  • walker
  • raised toilet seat
  • non-skid mats
  • hand-held shower
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9
Q

Bell’s Palsy

A
  • Disorder of the 7th cranial nerve
  • age 15 - 60
  • recovery 3-6 weeks
  • Inflammation r/t viral infection, usually herpes simplex, herpes zoster, Epstein-barr
    Risk factors: pregnancy, diabetes, URI

Diagnosis: EMG, CT

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10
Q

Symptoms of Bell’s Palsy

A
  • unilateral facial paralysis
  • droop smile
  • pain
  • sound louder on affected side
  • headache
  • loss of taste
  • changes in tear amount
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11
Q

Treatments for Bell’s Palsy

A
  • corticosteroids
  • antivirals
  • decompression surgery
  • eye drops
  • Vit B12, B6 and Zinc
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12
Q

Guillain-Barre

A
  • Inflammatory disorder where the immune system attacks the myelin sheath.
  • Starts in legs to trunk, then arms and cranial nerves.
  • No deep tendon reflex.
  • acute period: 10-20 days
  • 30% will need a ventilator
  • Recover: 2 weeks to 24 months
  • Risk factors: food poisoning, Hodgkin’s, HIV and Mono

Diagnosis: LP and EMG

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13
Q

Symptoms of Guillain-Barre

A 
weakness
paresthesias
difficulty with eye, facial movements
severe LBP
loss of B&B control
bradycardia
hypotension
dyspnea

Complications:
5% die
80% no permanent damage
5-10% permanent damage

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14
Q

Management of Guillain-Barre

A

plasmapheresis

immunoglobulins

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15
Q

Seizure disorders and Epilepsy

A

Causes:

  • birth injury
  • undetermined
  • vascular disease
  • head trauma/tumor
  • drug/ ETOH abuse
  • infection
  • genetics
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16
Q

Tonic/Clonic (GrandMal)

A
  • aura
  • cry
  • fall
  • tonus (stiffening)
  • clonus (jerkin)
  • urine
  • stool

Phases:

  • Prodromal: early signs of seizure onset
  • Aura: sensory warning
  • Ictal: full seizure
  • Postictal: recovery, very sleepy patient, muscle soreness, no memory of seizure
17
Q

Other generalized seizures

A

Typical Absence sz
- children, brief stare

Atypical absence sz
- stare and confusion

Myoclonic
- brief, cluster sz, in AM

Clonic
- jerks of same amplitude and decreasing frequency

Tonic
- children, loss of muscle tone, no clonicity

Atonic:
- sudden loss of tone

18
Q

Partial seizures

A
  • Simple partial seizure: without impairment of consciousness
  • Motor and/or sensory symptoms
  • Can go into tonic/clonic
  • Duration: 1 minute
  • Complex partial sz: change in level of consciousness
  • psychomotor sz
  • sensory distortions
  • Duration: average 2 min with postictal confusion
19
Q

Complications of Seizures

A
  • Brain injury: glucose and O2 are depleted from the neurons. Build up of lactate -> acidosis -> hypoxia -> cell death.
  • Status epilepticus: multiple seizures without regaining consciousness before the next. Cause: stopped meds.
  • Psychosocial: limited driving, negative stigma, unemployment
20
Q

Management of Seizures

A
  • heath history
  • labs: FBS, electrolytes, BUM, creatinine, UA
  • Skull xray, CT, MRI, EEG, LP
  • Treat any underlying cause
  • Medications, removal of precipitating factors and surgery

Valium 10 mg and Ativan 2-4mg

21
Q

Anticonvulsants

A
  • prevents or reduces excessive discharge of neurons with seizure activity
  • contraindications: alcoholism, DM, cardiac impairments, lactation
  • side effects: drowsiness, sedation, gingival hyperplasia (big cause of stopping meds), anorexia, hyperglycemia, N/V
  • teaching: life-long medication, take with food, no ETOH, must ok driving with MD, carry ID, must have drug levels drawn
22
Q

Nursing management during seizures

A
  • protect the patient - NO mechanical restraint
  • loosen constrictive clothing from neck
  • head on pillow or lap - LATERAL position
  • no object in mouth
  • note time, record observations

In case of Status Epilepticus:

  • IVP
  • O2 (nasal cannula)
  • suctioning
  • mainline IVF - glucose
  • external cooling

Do not remove dentures

23
Q

Nursing management after seizures

A
  • level of consciousness assessment and reorientation as needed
  • rest period of at least 30 minute with tonic/clonic
  • assess for Todd’s paralysis (focal motor weakness)
  • support family members
24
Q

Clinical manifestations of MS

A
  • symptoms reflective of damage area, gradual onset of vague symptoms
  • most common: visional changes, weakness (early in dz), unsteady gait, paresthesias, vertigo, elimination changes, cognitive changes, sexual dysfunction, fatigue
  • up to 50% of pts are ambulatory 25 years after initial diagnosis
  • No problems with pregnancy and lactation - but increase risk of exacerbation after pregnancy
25
Q

Multiple Sclerosis

A
  • autoimmune disease
  • destruction of the CNS myelin
  • 3rd common cause of disability in ages 15-60
  • more common further away from equator
  • usually white women - onset ages 20-40
  • lesions noted on MRI
26
Q

Symptoms and Drug Therapy for Multiple Sclerosis

A
  • Spasticity: Valium – SE: sedation
  • Tremor: Inderal, Klonopin (sedation)
  • Bladder: Ditropan - decreases urgency, incontinence – SE: dry mouth
  • Bowel: Metamucil, Colace
  • Fatigue: Symmetrel - improves endurance
  • Mood Changes: Elavil, Prozac
  • Immune System: Copaxone, Betaserone (self administered subq)
27
Q

Types of Multiple Sclerosis

A
  • Relapsing-Remiitting
  • Primary-Progressive
  • Secondary-Progressive
  • Progressive-Relapsing

Death from infections, immobility or other unrelated disease

28
Q

Parkinson’s Disease

A
  • Motor dysfunction of triads: resting tremor, rigidity, and bradykinesia (slow movement)
  • Caused by loss of nerve cells in the basal ganglia
  • In 1% of people over 50 (men over 60 most common)
  • Reduced level of dopamine
29
Q

Five stages of Parkinson’s Disease

A
  • Flexion of affected arm: Patient leans towards unaffected side
  • Slow shuffling gait
  • Difficulty walking - uses supports to prevent falls
  • Increasing weakness - Needs 1 assist
  • Profound disability - may be WC bound
30
Q

Triad of Symptoms of Parkinson’s Disease

A

Tremor:
- 1st sign, distal part of extremity present at rest, diminishes with activity, pill rolling common

Rigidity:
- Increase muscular stiffness present throughout ROM. When tremor present - cogwheel rigidity.

Bradykinesia:
- Slowing of body movement - most difficult to treat. Affects automatic behaviors - blink, swallow, facial expressions, arm swinging

31
Q

Nursing Care for Parkinson’s Disease

A

Drug Therapy:
- Sinemet: increases levels of dopamine in the brain. Prevents peripheral breakdown of the levadopa and more will reach the brain. Lost of side effects!

Self-care promotion:
- Safety, swallowing, prevent constipation, and other complications of decreased mobility, change positions, use rocking method, lift toes, communication impairments, suction and nutrition

32
Q

Myasthenia Gravis

A
  • Abnormal fatigue of voluntary muscles caused by defect in neurotransmission
  • autoimmune, amt of ACh recpetors decrease, which prevents ACh from attaching and stimulating contraction
  • Young, 20-30 women
  • genetic tendency
33
Q

Clinical Manifestations of Myasthenia Gravis

A
  • abnormal fatigue of voluntary muscles
  • ocular: unable to close eyes
  • diplopia Bulbar: speech and swallowing abnormalities
  • choking, smile changes, neck and shoulder weakness
  • trunk and limbs infrequently affected
  • weakness increases during the day
  • muscle stronger after rest period
  • no sensory loss
  • can have periods of remission
34
Q

Nursing care for Myasthenia Gravis

A

Teaching:

  • Do physical activities in the AM
  • limited amout of physical activity around mealtiime

Drug Therapy:

  • anticholinesterase
  • immunosuppressant
  • K

Drugs to avoid:

  • Mycins
  • Beta blockers
  • Lithium
  • Synthroid
  • BCP
  • Loop diuretics

Other therapies:

  • Surgery: removal of thymus
  • Plasma exchange: for acute treatment
  • Crisis management: severe weakness with resp failure
  • –Incidents: after URI, surgery, childbirth
  • –Goal: maintain gas exchange and patent airway
  • –Rule out cholinergic crisis (overdose of anticholinesterase)
35
Q

Amyotrophic Lateral Sclerosis (ALS)

A
  • Progressive spinal muscular atrophy
  • age of onset 40-70
  • death in 2-6 years (mean 3 years)
  • unclear etiology
  • genetic, men
  • autoimmune
36
Q

Clinical manifestations of ALS

A
  • decrease in fine motor movement
  • slow dragging gait
  • tires easily with walking
  • drooling
  • difficulty chewing and speaking
  • tongue contractions
  • muscle cramps and stiffness
  • respiratory failure is usual cause of death
  • mind is unaffected (pt watch body die)
37
Q

Nursing Care for ALS

A

Nutrition:

  • lots of time to eat
  • semisolid foods
  • oral hygiene
  • high fiber
  • small, frequent meals
  • avoid milk products

Mobility:

  • ROM
  • ADL’s, avoid fatigue

Pulmonary:

  • IS to Ventilator
  • G-tube to prevent aspiration

Elimination:

  • 64 oz fluid.
  • avoid caffeine
  • Bulk-forming meds
  • indwelling cath

Rest & Comfort:

  • ROM before bedtime to reduce cramping
  • alternating pressure mattress
  • elevate legs

Caregiver support:

  • be a listener
  • ALS support groups
38
Q

Nursing Implications with Drug Therapy

A
  • Dilantin: oral care, signs of toxicity, wean dose
  • Phenobarbital & Mysoline: observe for drowsiness. – SE: sedation, cognitive impairment, cheaper – Wean dose
  • Tegretol: wear dose, do not take with grapefruit juice. Watch cardiopulmonary status - Expensive
  • Depakene/Depakote: liver function tests, SE: GI distress, tremor, alopecia, weight gain
  • Valium & Ativan: IVP for status epilepticus. Do not use small hand veins - Atleast 5mg/min .. Pain with IM

NUB 350 (4 decks)

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