Neurological System Chronic Disease

Question 1

Peripheral Nervous System (PNS)

Answer 1

• sensory neurons run from stimulus receptors that inform CNS of stimuli
• motor neurons run from CNS to muscles and glands (effectors) that take action

Question 2

Central Nervous System (CNS)

Answer 2

• consists of spinal cord and brain

- subdivided into sensory-somatic and automatic nervous systems

Question 3

Sensory-Somatic Nervous System

Answer 3

12 pairs of cranial nerves
31 pairs of spinal nerves
-contain sensory and motor neurons
-all conscious awareness of external environment and motor activity to cope with it operate through sensory-somatic division

Question 4

Autonomic Nervous System

Answer 4

• consists of sensory and motor neurons that run between CNS (especially hypothalamus and medulla oblongata) and various internal organs (ie heart, lungs, viscera, glands)
• contraction of smooth and cardiac muscle is controlled by motor neurons of the autonomic system
• 2 subdivisions: sympathetic and parasympathetic nervous systems

Question 5

Sympathetic Nervous System

Answer 5

1) activates fight-or-flight response
2) sympathetic neurons frequently considered part of PNS, although many lie within CNS
3) sympathetic neurons of the spinal cord (which is part of the CNS) communicate with peripheral sympathetic neurons via series of sympathetic ganglia

Question 6

Parasympathetic Nervous System

Answer 6

1) main nerves of PNS are 10th cranial and nerves
2) parasympathetic stimulation causes slowing of heartbeat
- lowering of BP
- constriction of pupils
- increased blood flow to skin and viscera
- peristalsis of GI tract

Question 7

Parkinson’s Disease

Answer 7

goal of treatment:

1) medications to not halt progression of Parkinson’s disease (PD)
2) symptomatic relief from:
- dyskinesias
- resting tremors
- muscle rigidity
3) increased ability to perform ADLs by maintaining balance between dopamine and acetylcholine in extrapyramidal nervous system

Question 8

Parkinson’s Disease: medications

Answer 8

1) dopaminergics:
- levodopa (Dopar, Larodopa)
- Levodopa plus carbidopa (Sinemet)
2) dopamine agonists:
- pramipexole (Mirapex)
3) centrally acting anticholinergics
- benztropine (Cogentin)
4) dopamine releaser (antiviral):
- amantadine (Symmetrel)
5) dopamine agonists:
- ropinirole (Requip)
- bromocriptine (Parlodel)

Question 9

Common adverse effects of levodopa

Answer 9

1) nausea and vomiting
2) dyskinesias
3) orthostatic hypotension
4) discoloration of sweat and urine
5) activation of malignant melanoma

Question 10

Treatment of Myasthenia Gravis

Answer 10

1) anticholinesterase agents
- help improve neuromuscular transmission
- increase muscle strength
- neostigmine and pyridostigmine
2) immunosuppressive medications:
- prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and tacrolimus
- improve muscle strength by suppressing production of abnormal antibodies
- use must be carefully monitored by physician because they may cause major adverse effects

Question 11

Medications to treat Seizures

Answer 11

1) phenobarbital
2) phenytoin
3) carbamazepine
4) ethosuximide
5) valproic acid
6) gabapentin
7) diazepam

Question 12

phenytoin (Dilantin): nursing interventions and client education

Answer 12

1) advise clients about importance of oral hygiene
2) stop medication if client develops rash
3) encourage clients to consume enough vitamin D and calcium

Question 13

valproic acid: nursing interventions and client education

Answer 13

1) clients at risk for hepatotoxicity, pancreatitis, and thrombocytopenia
2) take medication with food
3) advise clients to observe adverse effects and to notify provider if occur:
- anorexia
- nausea, vomiting
- abdominal pain
- jaundice
- bruising

Question 14

Schizophrenia

Answer 14

• treatment goals
  1) suppressing acute episodes
  2) preventing acute recurrence
  3) maintaining highest possible level of functioning
• conventional antipsychotic medications control mainly positive symptoms:
• hallucinations
• delusions
• bizarre behavior of psychosis
• medications:
• chlorpromazine (Thorazine)
• haloperidol (Haldol)

Question 15

haloperidol (Haldol) Adverse Effects

Answer 15

1) Acute dystonia
- treat with anticholinergic agents, such as benzatropine (Cogentin) or diphenhydramine (Benadryl)
- use oral doses for less acute effects and IM or IV doses for serious effects
2) parkinsonism
- treate with benzatropine, diphenhydramine, or amantadine (Symmetrel)
3) akathisia
- manage effects with beta-blocker, benzodiazepine, or anticholinergic medication
4) late extrapyramidal symptoms (EPSs), tardive dyskinesia (TD)
- evaluate client after 12 months of therapy, then every 3 months
- if indications of TD appear, lower dosage or switch client to an atypcial agent

Question 16

Neuroleptic Malignant Syndrome: sudden symptoms

Answer 16

1) high-grade fever
2) BP fluctuations
3) dysrhythmias
4) muscle rigidity
5) change in LOC, developing into coma

Question 17

Neuroleptic Malignant Syndrome: nursing interventions

Answer 17

1) stop antipsychotic medication
2) monitor VS
3) apply cooling blankets
4) administer antipyretics (aspirin, acetaminophen)
5) increase fluid intake
6) administer diazepam (Valium) to control anxiety
7) administer dantrolene (Dantrium) to induce muscle relaxation