Neurological System Pt. 2

Question 1

What is a stroke?

Answer 1

Disruption of the blood supply to an area of the brain resulting in tissue necrosis and sudden loss of brain function.

Question 2

Ischemic stroke

Answer 2

Blood supply to an area of the brain is reduced resulting in ischemia.

Causes include embolism and thrombosis

Question 3

Hemorrhagic stroke

Answer 3

occurs secondary to rupture of a blood vessel often associated with hypertension

Question 4

Transient Ischemic Attack

Answer 4

Brief episode, less than 24 hours. Resolves within 30 - 60 mins. Warning of impending stroke.

Question 5

Hemiplegia

Answer 5

Paralysis of one side of the body

Question 6

Hemiparesis

Answer 6

Weakness of one side of the body

Question 7

Aphasia

Answer 7

loss of inability to comprehend or express speech

Question 8

Hemianopsia

Answer 8

Blindness in half of the vision field

Question 9

Agnosia

Answer 9

Loss of the ability to recognize objects

Question 10

How long do you have to give TPA to a stroke patient?

Answer 10

3 hours from stroke onset.

Question 11

Nursing mangement of acute phase of stroke

Answer 11

1) Maintain a patent airway and administer O2 as prescribed.
2) Monitor V/S
3) Suction secretions to prevent aspiration but never nasally or longer than 10 secs.
4) Monitor for  ICP
5) Position the client on the side to prevent aspiration with the HOB elevated to 15 - 30°
6) Monitor LOC, pupillary response, motor and sensory response, cranial nerve function, and reflexes.
7) Maintain a quiet environment.
8) Insert a urinary cath as prescribed
9) Administer IVF as prescribed
10) Maintain fluid and electrolyte balance

Question 12

Nursing mangement of post-acute phase of stroke

Answer 12

1) Position on the unaffected side for 2 hours and 20 minutes on the affected side; prone may also be prescribed
2) Provide mouth, skin and eye care
3) Monitor gag reflex and ability to swallow
4) Perform ROM exercises to prevent contractures
5) Place TED stocking on the client
6) Provide sips of fluids and slowly advance to solids.
7) Provie soft and semi-soft foods, thicken fluids for better toleration.

Question 13

Myasthenia Gravis

Answer 13

Autoimmune disease which results from antibodies blocking/destroying acetylcholine at the junction between nerves and muscle.

Question 14

What test is done to dx Myasthenia Gravis

Answer 14

Positive Tensilon Test - Edrophonium Chloride administration resulting in alleviation of symptoms.

Question 15

A patient arrives to AED presenting with diplopia, ptosis and dysphagia. She gave a positive result on the Tensilon Test. What first line medication would she be given?

Answer 15

Pyridostigmine Bromide (acetylcholinesterase inhibitor)

Question 16

On your rounds you recognize the patient in bed 4 has a B/P 97/49 mmHg, nausea, vomitting and diarrhea. On further assesment Tensolin has no effect. What do these symptoms represent?

Answer 16

Cholingeric Crisis

Occurs due to overmedication, Rest + Digest.

Question 17

You observe that James with Myasthenia Gravias exhibits a low urine output and bowel incontinence. Further investigations shows that his V/S were HR 110 bpm, RR 26 bpm and B/P 130/59 mmHg. What do these symptoms represent?

Answer 17

Myasthenic Crisis

Occurs due to overmedication and is a flight-or-fight response

Exacerbation characterized by severe generalized muscle weakness and respiratory weakness that may result in respiratory faiilure

Question 18

Guillain-Barre Syndrome

Answer 18

Autoimmune attack on myelin sheath of peripheral nerves resulting in demyelination and some craniel nerves leading to hyporeflexia, parestheia and ascending weakness with dyskinesia.

Question 19

Ataxia

Answer 19

poor muscle control that causes clumsy movements.

Question 20

Medical management

Answer 20

1) Administer TPE & IVIG which directly affects myeline antibody level
2) Provide respiratory therapy or mechanical ventilation
3) ECG monitoring
4) Alpha-adrenergic blocking agents
5) Anticoagulant agents

Question 21

Multiple Sclerosis

Answer 21

Progressive demyelinating disease of CNS

Immune-mediated

Question 22

Relapsing-remitting MS

Answer 22

Clearly, acute attacks with full recover or residual deficit with recovery

Question 23

Beta-Interferons

Multiple Sclerosis

Answer 23

Decreases no. of relapses of symptoms by decreasing inflammation & immune system’s response

Decreases WBC’s

e.g., Avonex

Question 24

What would ordered if patient has a relapse of MS?

Answer 24

Methylprednisolone IV

Question 25

Given to MS patients with bladder dysfunction

Answer 25

Oxybutynin by relaxing bladder muscles to prevent contractions

Question 26

Kim has multiple sclerosis and complained of issues emptying her bladder. What medication would the nurse expect to be prescribed.

Answer 26

Bethanecol

Question 27

Frank experiences fatigue attributed to Multiple Sclerosis? What medication is given for this symptom?

Answer 27

Amantadine

Question 28

Margaret has Multiple Sclerosis. During an exacerbation, she experiences muscle spasms. To improve spasticity, what medication would be given?

Answer 28

Baclofen, skeletal muscle relaxant
or
Diazepam (Valium)

Question 29

What drug masks tremors in MS?

Answer 29

Propanolol

Question 30

Seizure

Answer 30

Abnormal electrical signals are being rapidly fired by neurons in the brain.

Question 31

Epilepsy

Answer 31

Defined as a group of syndromes characterized by unprovoked reccurent seizures.

Question 32

What drug causes enlarged and bleeding gums, used to treat seizures?

Also causes osteomalacia (softening of the bones)

Answer 32

Hydantoins e.g., Phenytoin

Question 33

Prodromal phase

Answer 33

Sensation before the actual seizure

Headache, confusion, anxiety, anger and tremors

Question 34

Aura

Answer 34

Warning of an on-coming seizure and beginning of the ictal phase.

bitter/acidic taste, deja vu, flickering vision, hallucinations, buzzing sounds

Question 35

Ictal phase

Answer 35

Beginning and the end of the seizure

Arm or leg stiffening, confusion, lip smacking, dyspnea, drooling, inability to speak or move.

Question 36

Post-ictal phase

Answer 36

Is the recovery period post-ictal phase.

Extremity weakness, body soreness, drowsiness, fear

Question 37

Parkinson’s Disease

Answer 37

Chronic degenerative disorder that primary affects the neurons of the basal ganglia resulting in tremors, rigidity, bradykinesia and postural changes.

Question 38

What foods can not be given to a patient taken Levodopa & Carbidopa?

Answer 38

High in protein