Neurological Test 2 Flashcards
Discuss Parkinson’s disease and its possible complications. Please include the cause and expected findings.
Progressively debilitating disease affecting motor function.
List five expected findings in the client with Parkinson’s disease.
tremor
muscle rigidity
bradykinesia
postural instability
List a priority diagnosis for the client with advanced Parkinson’s disease.
Top priority is safety and aspiration, swallowing.
List two early symptoms of amyotrophic lateral sclerosis (ALS).
twitching and fatigue
Discuss amyotrophic lateral sclerosis (ALS) and nursing interventions related to this disorder.
What are the characteristics of the disease?
degenerative lateral sclerosis is a degenerative neurological disorder of the upper and lower motor neurons the result in deterioration and death of the motor neurons
results in progressive paralysis and muscle wasting that eventually causes respiratory paralysis and death.
How is amyotrophic lateral sclerosis (ALS) diagnosed?
diagnosed by Electromyogram, and muscle biopsy.
List a priority intervention for the client who has amyotrophic lateral sclerosis (ALS).
Airway and suction as needed.
What are the possible complications following a craniotomy? What might be expected findings?
SIADH
DI
Discuss meningitis including the definition, cause, signs, and at least 5 symptoms
Inflammation of the meninges, which are membranes that protect the brain and the spinal cord.
caused by: viral illness, fungal infections, bacterial infections, immunosuppression.
findings: constant excruciating headache nuchal rigidity (stiff neck) photophobia fever and chills altered LOC positive kernigs tachycardia seizures restless
Discuss Guillain-Barre syndrome. What are the possible signs and symptoms and complications of this disorder?
Develops in relation to acute destruction of the myelin sheath of peripheral nerves due to autoimmune disorder that results in varying degree of muscle weakness and paralysis.
weakness report of a virus previously 1-3 weeks acute progressive muscle weakness and paralysis muscle faccidity parasthesias diplopia facial weakness dysarthria dysphagia decreased
What causes Guillain-Barre syndrome? What are the priorities of care?
recent history of: acute illness viruses vaccination surgery
priorities of care: monitor respirations HOB elevated at 45 Monitor heart and BP assess gag reflex prevent skin breakdown
What are the expected findings in a client with a C4 spinal cord injury?
injuries are related to the diaphragm. client may or may not need intubation
loss of diaphragm function potential requirement of a ventilator for breathing limited ROM paralysis in arms, hands, torso and legs trouble controlling bladder/bowel
Define neurogenic shock and paralytic ileus.
common response of the spinal cord following an injury. symptoms include bradycardia, hypotension, faccid paralysis,, loss of reflex activity below of injury and paralytic ileum accompany spinal shock due to the loss of automatic function.
List five nursing interventions for the client who has meningitis. List the assessment that would be priority. List an intervention that would be priority.
isolate client as soon as meningitis is supsected maintain isolation precautions (droplet) neuro checks and VS q2-4 hours implement fever reduction decrease environmental stimuli maintain bed rest with HOB elevated to 3-0 monitor client fro increased ICP maintain client safety seizure precautions monitor IV fluids and electrolytes
Discuss myasthenia gravis. What are the expected findings? How treated?
A progressive autoimmune disease that produces severe muscle weakness. Characterized by periods of exacerbation and remission. Muscle weakness improves with rest.
findings: impaired respiratory status decreased swallowing ability poor muscle strength incontinence drooping eyelids poor posture
Which medications are used to treat myasthenia gravis?
cholinesterase inhibitor meds are first line
pyridostigmine (Mestinon) neostigmine (Prostigmin) Imurane Deltasone Prednisone
Compare and contrast cholinergic crisis and myasthenic crisis.
Myasthenic crisis: occurs when clients are experiencing a stressor that causes an exacerbation of MG, such as infection
Cholinergic crisis: is when clients have taken too much cholinesterase inhibitor.
What do clients with myasthenia gravis, Guillain-Barre syndrome, and amyotrophic lateral sclerosis have in common?
muscle weakness
dysarthria
dysphagia
all 3 do not have a cure
Discuss multiple sclerosis (MS). Include the cause and expected findings. What are possible exacerbation triggers?
Neurologic disease that affects the spinal cord, typically resulting in difficulties with gait, strength, and motor function
triggers: viruses and infectious agents living in a cold climate physical injury emotional stress pregnancy fatigue temperature extremes how shower/bath
Discuss Alzheimer’s disease including the cause and expected findings
nonreversible type of dementia that progressively develops over many years. subtype of neurcognitive disorder that is neurodegenerative, resulting in the gradual impairment of cognitive function.
advanced age genetics environmental agents (herpes, metal/toxic) previous head injury family history of alzheimers or downs
What signs and symptoms would the nurse expect in the client with stage 6 Alzheimer’s disease? (according to lecture material)
memory difficulties continue to worsen, loss of awareness of recent events and surroundings, may recall own name but not personal astray, delusions, hallucinations, compulsive h=behavior, wandering behavior, requires assistance in ADLs, normal sleep cycle disturbed, increased episodes or urinary/fecal incontinence
List 5 symptoms of Alzheimer’s disease.
forgetfulness assistance in ADLS urinary/fecal incontinence disrupted sleep cycle unrecognizable speech
List five risk factors for cerebral vascular accident (CVA).
cerebral aneurysm arteriovenous malformation DM obesity HTN atherosclerosis hyperlipidemia hypercoagulability A Fib use of oral contraceptives smoking cocaine use
Which type of stroke is associated with emboli?
embolic stroke
Describe TIA. What is the difference between TIA and stroke?
TIA sudden, short lived attack
stroke is a disruption in the cerebral blood flow secondary to ischemia hemorrhage or embolism
Describe homonymous hemianopsia. List two nursing interventions for this disorder?
loss of visual field in one or both eyes
Discuss the purpose of an endarterectomy.
carotid endarectomy is performed to open the artery by removing athersclerotic plaque. This procedure is performed when the carotid artery is blocked or when the client is experiencing TIAs
Define dysphagia, dysphasia, and dysarthria?
dysphagia: difficulty swallowing
dysphasia: difficulty speaking
dysarthria: slow or slurred speach.
Describe “unilateral neglect”. What are the nursing interventions for unilateral neglect.
loss of awareness of the side affected by the CVA. Clients are unable to see, feel, or move the affected side of the body, therefore they forget that body part exists.
observe for injury
apply arm sling during transport
ensure the foot rests on foot rest
Define autonomic dysreflexia.
occurs secondary to the stimulation of the sympathetic nervous system and inadequate compensatory response by at the parasympathetic nervous system. Clients who have lesions below T6 do not experience dysreflexia because the parasympathetic nervous system is able to neutralize the sympathetic response.
Discuss the interventions for the client experiencing autonomic dysreflexia.
relive the kink in the catheter or irrigate
catheterize clients
remove the impaction
adjust the room temp and block drafts
remove tight clothing
check for injury such as lower extremity fx
monitor VS for sever HTN and bradycardia
List two priorities of care for the client who has quadriplegia.
maintain respiratory function
maintain tissue perfusion
List a priority nursing diagnosis for the client who has a C5 spinal cord injury (SCI).
damage to spinal cord at c5 affects vocal cords.
nanda: ineffective breathing pattern
Discus the expected findings in the client with a transection of the spinal cord at T4.
loss of diaphragm function
potential requirement of a ventilator for breathing
limited ROM
paralysis in arms, hands, torso, legs
trouble controlling bowel and bladder function.
Which would the nurse expect to see in a client with T12 spinal cord injury?
good upper body control depending on the level of cord damage
lack of function in the legs and or torso resulting in paraplegia
lack of bowel/bladder control
possible reduced ability to control the truck of the body or abd. muscles
good balance while in a sitting position
ability to stand in a specialized frame or walk with braces
.
Define atelectasis. What are the nursing interventions to prevent atelectasis?
.airway inflammation and edema lead to alveolar collapse and increased risk of hypoxemia
encourage client to turn, cough and deep breath q2h
encourage client to use incentive spirometer
How would you expect the client with a C2 spinal cord injury to be treated?
mechanical ventilator
physical therapy
prescription drugs
surgery to relieve pressure from spinal cord and fuse segments together
Define diplopia. How is it treated?
double vision
treatment: alternating eye patches prism glasses surgery mestinon for MG
What type of medication is donepezil hydrochloride (Aricept)? Which disorder is it used to treat? What does it do for this client? What are the side effects?
acetylcholinesterase inhibitor.
used to treat alzheimer’s disease
side effects: frequent stools upset stomach dizziness headache lightheadedness unsteady gait
What type of medication is pamipexole (Mirapex)? Which disorder is it used to treat? List to possible side effects associated with this medication?
dopamine agonist activate the release of dopamine
used for parkinson’s
side effects: orthostatic hypotension hallucinations constipation raynauds phenomenon dyskinesias and insomnia
Why is aspirin prescribed in the client who experiences transient ischemic attacks (TIA’s)?
it changes the vascularity of the blood. blood thinner.
What time of medication is Clopidogrel (Plavix), Osmitrol (Mannitol), Nifedipine (Procardia), and Dexamethasone (Decadron)? Which of these would not be used in the client with a hemorrhagic stroke?
apririn/plavix thins the blood and prevents clots but is not used in clients who have had hemorrhagic stroke as it can cause more bleeding
List the categories of medications used to treat Parkinson’s disease.
- Dopaminergic: levodopa (Dopar) - this may be combined with cardidopa (Sinemet) to decrease peripheral metabolism
- Dopamine agonists: bromcriptine (Parlodel), (Mirapex)
- Anticholingergics: benztropine (Cogentin), trihexyphenidyl (Artane)
- COMT inhibitor: entacapone (Comtan) decreases breakdown of levodopa
- Antivirals: amantadine (Symmetrel)
What type of medication is neostigmine (Prostigmin)? How does it work in the body? Which disorder is it used to treat? What medication should the nurse have on hand in case of an overdose?
in most people with myasthenia graves, the immune system blocks or damages these acetylcholine receptors.
What type of medication is bromocritine (Parlodel)? List two common side effects.
Dopamine agonist
causes:
ORTHOSTATIC HYPOTENSION
DYSKINESIAS
HALLUCINATIONS
What type of medication is riluzole (Rilutek)? Discuss the teaching to be provided to the client.
glutamate antagonist
avoid alcohol
take med at scheduled time
store away from light
List two medications used in the treatment of multiple sclerosis (MS)
Azathiprine (Imuran) cyclosporine (Sandimmune) prednisone (Deltasone) dantrolene (Dantrium) tizanidine (zanaflex) baclofen (Lioresal) diazepam (Valium)
What is atrial fibrillation? What type of medication would you anticipate to be given to a client who has atrial fibrillation and is experiencing TIAs?
irregular rapid HR that causes poor blood flow. anticoagulant such as dabigatran (Pradaxa)
What type of medication is deamthasone (Decadron)? Discuss the use of this medication in the spinal cord injury client and the stroke client.
steroid/immunosuppressant used to treat inflammation, lessen cerebral edema, decrease ICP and strengthen the blood brain barrier
List a contraindication for administering benztropine (Cogentin) to a client.
contraindicated in patients with glaucoma. This drug will increase IOP.
What type of medication is baclofen (Lioresal)? Which neurologic disorders might it be used for? What symptoms does it treat?
muscle relaxant used to treat muscle spasms. it is used to treat multiple sclerosis symptoms such as spasm, pain and stiffness.
Discuss Huntington’s disease including the cause and expected finding.
chronic, progressive, hereditary condition. premature death of brain cells in the basal ganglia
abnormal involuntary movement
personality changes, mood swings
difficulty making decisions
confined to bed
Explain plasmapheresis. What is the purpose for this treatment?
Plasmapheresis is a process that filters the blood and removes harmful antibodies. It is a procedure done similarly to dialysis; however, it specifically removes antibodies from the plasma portion of the blood.
