Pellico CH 46 Neuro Disorders

Question 0

What are the 2 types of Partial Seizures? What are the characteristics of each?

Answer 0

1) Simple Partial Seizure (no loss of consciousness)

2) Complex Partial Seizure (loss of consciousness involved)

Question 1

What is the difference between a Partial Seizure and a Generalized Seizure?

Answer 1

1) Partial Seizure - A seizure that is limited to one side of the cerebral hemisphere.
2) Generalized Seizure - A seizure that involves the brain difusely.

Question 2

What are the 7 types of Generalized (Grand Mal) Seizures?

Answer 2

1) Tonic-Clonic - Begins with rigidity (tonic phase) followed by stiffening and jerking of body and extremities (clonic phase).
2) Tonic
3) Clonic
4) Absence (Petit Mal) Seizures - Short episodes of staring and loss of awareness.
5) Atonic Seizures - Sudden loss of muscle tone, resulting in falls or a drop to the ground, with rapid recovery.
6) Myoclonic Seizures - Bilateral jerking movements of a muscle or muscle gout without Los of consciousness.m
7) Unclassified Seizures

Question 3

What are the 8 clinical manifestations of the pos-ictal state?

Answer 3

1) Confusion
2) Lethargy and sleepiness (PT is hard to arouse)
3) Headache
4) Sore muscles
5) Extremity weakness
6) Fatigue
7) Depression
8) Noisy breathing

Question 4

Which 3 nursing interventions should be implemented for a patient in Status Epilepticus?

Answer 4

1) Padding
2) Suction
3) Oxygen

Question 5

Which drug class is used for a patient in Status Epileticus?

Answer 5

Bezodiazepines - I.e., Diazepam (Valium), Lorazepam (Ativan), and Phosphenytoin (Cerebyx) are given IV.
*other meds such as Phenytoin and Phenobarbitol are administered later to maintain a seizure-free state.

Question 6

Phenytoin (Dilantin) can be given via IV post-ictally to maintain a seizure-free state. Which maintenance fluid is Dilantin incompatible with and what should the nurse do if the Pre-existing solution contained this fluid?

Answer 6

Dilantin precipitates in D5W and therefor must be given with normal saline instead. If D5W was running, the nurse should flush the IV line with normal saline before administering the med.

Question 7

Describe the following positive signs found in a patient with Meningitis:

1) Nuchal Rigidity
2) Kernig’s Sign
3) Brudzinski’s Sign
4) Photophobia

Answer 7

1) Nuchal Rigidity - Stiff neck, which is an early sign.
2) Kernig’s Sign - Resistance to passive extension of the knees when the patient is lying supine.
3) Brudzinski’s Sign - Flexion of the knees and hips when the patients neck is flexed.
4) Photophobia - Extreme sensitivity to light.

Question 8

How is HSV-1 Encephalitis diagnosed and treated?.

Answer 8

1) Diagnosis - The Polymerase Chain Reaction (PCR) is the standard test for early diagnosis.
2) Acyclovir (Zovirax), an antiviral agent, is the medication of choice for Tx if HSV-1.

Question 9

Why is the effect of the HSV-1 virus on the brain and what are the initial symptoms of HSV-1 Encephalitis?

Answer 9

1) The invading organism causes cerebral edema and petechial hemorrhages of the brain and can directly invade the brain, damaging neurons.
2) initial symptoms include fever, headaches, stiff neck, and confusion.

Question 10

Which medication is used to treat Spasticity in patients with Multiple Sclerosis and how does it work?

Answer 10

Baclofin (Lioresal), is used to treat muscle spasticity patients with MS. It can be administered intrathecally.
Since it is a GABA agonist, it is a inhibitory NT that controls spasms or messages from the CNS.

Question 11

What is the Neurotransmitter involved in Myasthenia Gravis?

Answer 11

Acetylcholine

Question 12

What are the clinical manifestations of Myasthenia Gravis?

Answer 12

1) Diplopia and Ptosis (initial symptoms)
2) Weakness of the face and throat (bulbar) and generalized weakness
3) Dysphonia (voice impairment caused by laryngeal involvement)
4) Enlarged thymus

Question 13

What is the implication of rest on the energy level of patients with Myasthenia Gravis?

Answer 13

Resting increases the energy level of patients with Myasthenia Gravis, therefore, they are usually at their strongest and most energetic in the mornings.

Question 14

(T/F) Parkinson’s Disease is slowly progressing neurologic movement disorder that eventually lead to disability, so Tx becomes less effective overtime.

Answer 14

True

Question 15

Describe the pathophysiology of Parkinson’s Disease.

Answer 15

PD is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantial Nigra in the basal ganglia region of the brain.
The loss of dopamine stores in his area of the brain results in more excitatory NTs (Ach) than inhibitory, which affects voluntary movement.
Cellular degeneration impairs the Extrapyramidal tracts that control semiautomatic fxns and coordinated movements.

Question 16

Which meds are used in the Tx of Parkinson’s Disease and what are their side effects?

Answer 16

1) Levodopa (Laradopa), which is converted to dopamine in the basal ganglia is the most effective agent. It is usually administered with Carbidopa (Sinemet), which helps to maximize its effects.
2) Side Effects include dyskinesia, facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk extremities.

Question 17

What is Amyotrophic Lateral Sclerosis (ALS) and what usually causes death in these patients?

Answer 17

ALS is a degenerative disease characterized by the loss of both lower and upper motor neurons.
Death usually occurs as a result of respiratory failure.

Question 18

Describe Guillain-Baré Syndrome (GBS). What usually causes death n these patients?

Answer 18

GBS is an autoimmune attack on the peripheral nerve myelin producing ascending weakness with dyskenesia, hyperreflexia and paresthsias. Attack is n the myelin (not the Schwaan cells that make the myelin), so re-myelinization is possible.
Patients usually die from respiratory failure.