neuro

Question 1

multiple sclerosis

Answer 1

CNS (brain and spinal cord)
chronic, autoimmune, degenerative
inflamed nerve
loss of myelin (protects the nerves)
increase in oligodendrocyte (cells that produce myelin)
patches of plaque in white matter of CNS
schwann cells destroyed

Question 2

MS triggers

Answer 2

infection, trauma, pregnancy, fatigue, stress
RRMS (relapse remit) 85% start with this, exacerbations and remissions
PPMS (primary progressive) symptoms gradually worsen
SPMS (secondary progressive) 10-25 years of RRMS, no real recovery
PRMS (progressive relapsing), escalates severely, few remission periods

Question 3

MS etiology and contributing factors

Answer 3

unknown, age 20-40, immune system malfunction, viral, genetics, environmental
high suicide rate
maintain normal family function

Question 4

MS diagnosis

Answer 4

history, mcdonald criteria (2 episodes one month apart), neuro symptoms (blurred vision, muscle weakness)
MRI
evoked potential

Question 5

MS clinical manifestations

Answer 5

visual blurring, diplopia, blindness, nystagmus, oscillopsia
intentional tremors, poor condition, numbness, spasm, sensitivity to heat, fatigue, lassitude (collapse), poor memory, judgment, and reasoning

Question 6

MS nursing management

Answer 6

relieve symptoms, mobility (ROM exercises), bladder, high fiber diet
prevent overheating
wide-based gate walk
increase fluids to relieve constipation
void every 2 hrs to prevent UTI
kegel exercises
avoid laxatives

Question 7

MS pharmacologics

Answer 7

anticholinergics
amantadine HCL
antidepressants
beta blockers
antihistamines
muscle relaxants (baclofen)- spasticity
immunoregulatory (avonex, beta-interferon, rebif, copaxone, etc)

Question 8

myasthenia gravis

Answer 8

autoimmune neuromuscular disease
acetylcholine receptors depleted
weakness (hallmark symptom) in the presence of sustained contraction
relieved with rest

Question 9

myasthenia gravis clinical manifestations

Answer 9

ocular-diplopia and ptosis (drooping eyelid)
facial- dysphagia, dysphonia, mastication
larynx- dysarthria, aspiration, dysphagia
limbs- unsteady gait
weak diaphragm

Question 10

myasthenia gravis diagnosis

Answer 10

tensilon test or edrophonium chloride- blocks breakdown of acetylcholine, given 2mg of tensilon injected IV. if muscle tone increases, an additional 8mg is given
no response= pt given bromide injected IV
serum tests- antibodies to SCH receptors
electromyography (EMG)
chest x-ray (enlarged thymus gland)

Question 11

myasthenia gravis complications

Answer 11

myasthenia crisis- under dose, increase anticholinesterase drugs
cholinergic crisis- overdose, decrease anticholinesterase drugs

Question 12

myasthenia gravis drugs

Answer 12

anti-cholinesterase (bromides)
immunosuppressives (prednisone, cytoxan)
plasmapheresis (removed acetylcholine receptor antibodies)
thymectomy (thymus excision)

Question 13

myasthenia gravis nursing management

Answer 13

medications at exact same time
given 30-60 min before meals
given before ADL’s
cut food into small bites, sit upright
main meal= when pt is least fatigued (AM over PM)
protect eyes (sunglasses)
wear medical alert bracelet
may need artificial tears
rest periods throughout the day

Question 14

parkinsons disease

Answer 14

affects voluntary movement
chronic neurodegenerative disease, juvenile
idiopathic (unknown cause)
latrogenic (caused by drugs)
more men than women
destruction of cells in substantia nigra
DECREASED DOPAMINE
loss of control, coordination, and initiation of voluntary movement

Question 15

post encephalitic parkinsonism

Answer 15

pt had encephalitis as a kid, developed parkinson’s symptoms as they aged

Question 16

Parkinson’s cardinal signs

Answer 16

tremors (resting, micrographia, pill-rolling)
supination/pronation
bradykinesia
rigidity
resting tremors disappear with slow, purposeful movement
propulsive gait
festination (short, shuffling steps)
hypomimia
dysphagia
rigidity of chest wall
TRAP tremors rigidity akinesia postural instability

Question 17

parkinsons teaching

Answer 17

high risk for falls, no rugs
firm chairs with arms
velcro/slip on shoes and clothes with buttons
rock back and forth to get up
eat sitting upright
wide based gait
raised toilet seat

Question 18

parkinsons disease nursing care

Answer 18

give semi solid foods with thickeners for dysphagia
diet: pyridoxine, no alcohol, NOT high protein (should be evenly distributed)
refer to nutritionist
drug holiday: pt in quiet room with subdued lighting
physical therapist for movement
speech pathologist for swallowing

Question 19

parkinsons diagnosis

Answer 19

presence of symptoms
trial of levodopa (consistent response to the drug rules out parkinson’s like syndrome)
pt may have to walk the length of the room to be observed for rigidity and resting tremors

Question 20

parkinsons medical management

Answer 20

levodopa (hallmark treatment), benefits only last 5-10 years so this is the last treatment given
carbidopa (combination= sinimet), gets more levodopa to the brain
nonergot derivatives (requip, mirapex)
dopamine antagonist (parlodel, permax)
MAOIs (selegiline)
antiviral (amantadine)
COMT inhibitors
antidepressants, antihistamines

Question 21

guillian barre

Answer 21

life threatening autoimmune syndrome
affects peripheral nervous system

Question 22

clinical manifestations of guillian barre

Answer 22

rapid onset of pain
ascending pattern
paralysis (over a few hours, lasting 1-4 weeks), paresthesia
dyskinesia
loss of DTR
respiratory paralysis (late symptom)
vocal paralysis
bladder incontinence/incomplete emptying
constipation, dizzy, cramps, BP affected

Question 23

nursing management guillian bare

Answer 23

ventilator, incentive spirometer, chest PT, suction to prevent aspiration, mobility, HOB15-30º. passive ROM, thigh high stockings, check bowel sounds, monitor gag reflex, TPN or G tube
refer to speech pathologist

Question 24

patrial (focal) seizure

Answer 24

simple partial
no loss of consciousness
changes in site, hearing, smell, may involve 1 finger
aware of surroundings but cannot control
lasts 30 seconds

Question 25

complex partial seizure

Answer 25

loss of consciousness
automatism (purposeless repetitive symptoms like lip smacking, picking at clothes, tapping)
blacks out
bizarre behavior

Question 26

generalized seizure

Answer 26

involves the entire brain
tonic-clonic
absence seizure
myoclonic
atonic

Question 27

tonic clonic preictal phase

Answer 27

aura- brief sensory experience that occurs a few seconds before seizures
ex. strange odor, mild depression, irritability

Question 28

clonic phase

Answer 28

2-5 minutes
jerking of extremities
rhythmic shaking, muscle contractions, and relaxation
incontinence, may be foaming from the mouth
turn head to the side

Question 29

postictal phase

Answer 29

deep sleeping (30 min to 4 hr)
disorientation (no memory of seizure)
confusion
weakness
headache
muscle ache
documentation is important!

Question 30

absence seizure

Answer 30

brief loss of consciousness
vacant facial expression
rapid blinking
often disappears after puberty

Question 31

myoclonic seizure

Answer 31

brief jerking of muscles
brief loss of consciousness

Question 32

atonic seizure

Answer 32

loss of muscle tone
falls to the floor, briefly nods off
confused post ictal
must wear protective head gear

Question 33

seizure diagnostic tests

Answer 33

history
EEG (within 24 hrs of seizure)
computer tomography
MRI
telemetry (brain activity monitor)
videotaping

Question 34

pharmacological therapy/ seizure management

Answer 34

control, raise threshold, therapeutic blood level, monitor for allergies/toxicity, give meds at same time each day
switching meds: 1 med is tapered as the other is increased
phenytoin, carbamazepine, clonazepam, diazepam or lorazepam (IV), luminal (phenobarbital)

Question 35

seizure patient teaching

Answer 35

phenytoin causes gingival hyperplasia, hirsutism, hypothermia, diplopia, BMS
avoid triggers
take meds on time and correct dose
avoid dangerous activities
wear protective headgear
lie down if experiencing aura
meticulous oral hygiene with phenytoin
wear medical alert bracelet

Question 36

nursing care for seizures

Answer 36

assess for aura and triggers
establish/maintain airway
move objects, remain until consciousness returns
do not insert anything into mouth
turn head to the side
padded siderails on the bed
do not restrain or shout
call ambulance if seizure is longer than 10 minutes
oxygen/trach equipment at bedside
maintain saline lock for pt incase medication is needed