Central and Peripheral Nervous System Disorders

Question 1

used to manage and treat epilepsy, generalized tonic-clonic seizures, complex partial seizures, and status epilepticus. Is an anticonvulsants drug

Answer 1

Phenytoin

Question 2

Stops the production of certain natural substances that cause fever, pain, swelling, and blood clots. Salicylates drug

Answer 2

Aspirin

Question 3

takes away headaches and eases other symptoms like feeling or being sick and sensitivity to light and sound. A selective serotonin receptor agonists, works by narrowing blood vessels in the head. Used for cluster and tension headaches

Answer 3

Sumatriptan

Question 4

treats Parkinson’s disease by improving muscle control and reducing stiffness, this medicine allows more normal movements of the body as the disease symptoms are reduced. Works by blocking acetylcholine

Answer 4

Benztrophine

Question 5

treats epilepsy, it slows the electrical signals down to stop seizures.

Answer 5

Levetiracetam

Question 6

to treat relapsing form of MS, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

Answer 6

Betaseron

Question 7

water-soluble, an ionized compound that reversibly inhibits the enzymes acetylcholinesterase. To treat a muscle disease called myasthenia gravis. Also given after surgery to help reverse the effects of certain types of medications that have been used to relax the muscles.

Answer 7

Neostigmine

Question 8

treats Parkinson’s disease

Answer 8

Levodopa-Carbidopa

Question 9

: treats epilepsy by reducing the abnormal electrical activity in the brain. Can be used for nerve pain too.

Answer 9

Gabapentin

Question 10

Checks level of consciousness. Highest they can get is at 15 and that is normal and less than 7 is abnormal gcs and indicates a comatose state.

Answer 10

Glasgow Coma Scale

Question 11

-Patho: Dilation or constriction of cerebral blood vessels in response to changes in blood pressure, blood oxygen levels, and blood pH maintains constant and consistent tissue perfusion.
-Causes: Inoperable Brain tumors, Swelling or bleeding from head trauma, Infectious and inflammatory disorders of the brain (meningitis, encephalitis)
-Consequences: impaired cellular activity, temporary or permanent neurologic dysfunction, death
-S/S: Decreasing level of consciousness (LOC), Decreased Glasgow Coma scale, Stuporous, semicomatose, comatose; confusion, restlessness, periodic disorientation, Headache—more severe in the morning, just not going away, extreme vomiting
-Cushing triad: a pulse rate that increases initially but then decreases, systolic BP that rises with a widening pulse pressure, and a respiratory rate that is irregular
-Cheyne–Stokes respirations (look this up)
-Other: vomiting, papilledema, decorticate or decerebrate posturing (look these 2 up)
-Diagnostics: skull radiography, computed tomography (CT), magnetic resonance imaging (MRI), lumbar puncture, cerebral angiography
-Medical Management: Goals: maintain BP, prevent hypoxia, and ensure cerebral perfusion
-Isotonic normal saline, lactated Ringer, hypertonic (3%) saline solutions: avoid hypotonic solutions and solutions containing glucose because they increase ICP
-Supplemental oxygen: keep SaO2 at 95%, Maintain head in midline at 30° of elevation, Avoid hypothermia.
-Control seizures; administer diazepam (Valium), Sedate agitated clients: midazolam (Versed) hyperactivity contributes to transient rises in ICP
-Indwelling catheter, nasogastric tube, stool softener, histamine antagonist; famotidine (Pepcid; PPI)

Answer 11

Increased Intracranial Pressure

Question 12

Which of the following nursing interventions will help prevent further increase in ICP?

Answer 12

Elevate the head of the bed.

Question 13

Rare and hard to diagnose. Person has been sick in the last few weeks

Answer 13

Guillain-Barre Syndrome

Question 14

-Patho: antibodies attack the Schwann cells that make up the insulating myelin sheath; the affected nerves become inflamed and edematous
-Causes: unknown, autoimmune reaction, influenza, lupus erythematosus
-S/S: weakness, numbness, tingling in the arms and legs, progressive weakness, paralysis
-Other: difficulty chewing, talking, and swallowing
-Paralysis ascends→ may need intubation and suction
-Diagnostics: Lumbar puncture, electrophysiologic testings (assess heart’s electrical system)
-Medical Management: Plasmapheresis (remove plasma & reinfuse cells from blood), immune globulin (Gamimune N)
-Nursing Management: Assess signs of respiratory distress, spirometer, skin care, change position every 2 hours, ROM exercises to prevent muscle atrophy

Answer 14

Guillain-Barre Syndrome

Question 15

-Patho: infection in nearby structures such as the middle ear, sinuses, or teeth
-Causes: intracranial surgery or head trauma; bacterial endocarditis, bacteremia, pulmonary or abdominal infections
-S/S: increased ICP, fever, headache, paralysis, seizures, muscle weakness, lethargy
-Diagnostic Findings: Laboratory tests: WBC count, lumbar puncture, CT scan, MRI, skull radiographs
-Medical Management: Antimicrobial therapy, control of fever, mechanical ventilation, IV fluids, nutritional support
-Surgical Management: craniotomy
-Nursing Management See Nursing Care Plan 37-1: Assessment for altered LOC; Assess changes in sensory and motor functions; Signs of increased ICP; monitor vital signs; I&O

Answer 15

Brain Abscess

Question 16

-Patho: Demyelinating disease; causes permanent degeneration and destruction of myelin sheath
-S/S: Blurred vision, diplopia, nystagmus, weakness, clumsiness, and numbness and tingling of an arm or a leg; an intention tremor and slurred, hesitant speech (scanning speech); mood swings
-Others: motor incoordination, bowel and bladder incontinence, loss of memory, difficulty concentrating, impaired judgment
-Diagnostic Findings: Lumbar puncture and CSF analysis, Electrophoresis of CSF, CT scan and MRI
-Nursing Diagnosis: Risk for Ineffective Breathing Pattern related to weakening of muscles for respiration; Encourage clients to deep breathe several times. Place client in a Fowler position and support the arms. Impaired Physical Mobility related to diminished muscle strength and inactivity; Provide rest between bathing, eating, and ambulating.Baclofen (Lioresal) and dantrolene (Dantrium) for muscle spasticity and rigidity

Answer 16

Multiple Sclerosis

Question 17

-Diagnostics: Diagnostic confirmation is made by IV administration of edrophonium (Tensilon), Relieves muscular weakness in a few seconds; the restored muscle strength dissipates in minutes
-Acetylcholine receptor antibody titer, Chest radiography may show an enlargement of the thymus (thymoma)., Electromyography: measures the electrical potential of muscles
-Medical Management: Administration of anticholinesterase drug; pyridostigmine bromide (Mestinon). Therapeutic effect prolongs the action of acetylcholine, which sustains muscle contraction. Prednisone, immunosuppressant, plasmapheresis
-Surgical management: removal of the thymus gland
-Nursing Management: Provide periods of rest; elevate the head of a bed; suction secretions; demonstrate patience and empathy to help the client deal with his or her changes in appearance, function, and lifestyle. The nurse must administer medications at the exact intervals ordered to maintain therapeutic blood levels and prevent symptoms from returning

Answer 17

Myasthenia Gravis

Question 18

-Patho: Degeneration of the motor neurons of the spinal cord and brainstem; results in muscle weakness and wasting
-Cause: unknown
-S/S: Progressive muscle weakness; wasting of the arms, legs, and trunk develop; client experiences episodes of muscle fasciculations (twitching). If ALS affects the brain stem—difficulty speaking and swallowing, periods of inappropriate laughter and crying, respiratory failure and total paralysis
-Diagnostics: No specific diagnostic tests are available.
-Electromyography: validates weakness in the affected muscles
-Medical Management: No specific treatment, and death occurs several years after diagnosis. Treated with riluzole (Rilutek), which slows the progression of ALS and delays the need for a tracheostomy
-Nursing Management: Assistance with ADLs in the beginning stages and total dependence on staff and family for ADLs in the later stages

Answer 18

Amyotrophic Lateral Sclerosis (ALS)

Question 19

-Patho: Involves the fifth (V) cranial nerve (the trigeminal nerve), which has three major branches: mandibular, maxillary, and ophthalmic
-This sensory and motor nerve is important to chewing, facial movement, and sensation.
-Cause: unknown; related to compression of the trigeminal nerve root
-S/S: sudden, severe, and burning pain
-Diagnostics: Skull radiography, MRI, CT scan
-Surgical Management: If medical management is unsatisfactory, surgical division of the sensory root of the trigeminal nerve provides permanent relief.
-Nursing Management: Identify the location, pattern, and events associated with pain. Inspect the oral cavity for signs of injury. Nurse should offer small nutrient-dense meals of soft consistency. Foods may be pureed to minimize jaw movements when eating.

Answer 19

Cranial nerve Disorders Trigeminal Neuralgia (Tic Douloureux)

Question 20

-Patho: Inflammation occurs around one of the paired facial nerves, blocking motor impulses to muscles on one side of the face
-Cause: unknown; viral link is suspected
-S/S: facial pain, pain behind the ear, numbness, diminished blink reflex, ptosis of the eyelid, tearing on the affected side occurs
-Diagnostics: Based on symptoms and visual examination of the face
-Medical Management: Corticosteroid therapy combined with an antiviral acyclovir (Zovirax) to inhibit viral replication and shorten the duration of symptoms, Analgesics prescribed for pain
-Nursing Management: Obtain the client’s history; viral infection; Perform a physical examination to determine which side of the face is involved. Assess for speech impairment and observe the client’s ability to chew and swallow food.

Answer 20

Bell’s Palsy

Question 21

-Patho: Deficiency of the neurotransmitter dopamine
-Causes: unknown; exposure to environmental toxins such as insecticides, herbicides, self-administration of an illegal synthetic form of heroin known as MPTP
-Others: sequelae of head injuries and encephalitis
-Phenothiazines (category of antipsychotic drugs)
-Diagnostics: based on typical symptoms and neurologic examination; no specific tests
-Medical Management: (See Drug Therapy Table 37-1) Drug therapy goal: prolong independence; selegiline (Eldepryl), levodopa (Larodopa)
-Physical therapy, occupational therapy, client and family education; nutritional counseling
-Surgical Management: Stereotaxic pallidotomy, deep brain stimulation (DBS), gene therapy, glial cell–derived neurotrophic factor (GDNF)
-S/S: Stiffness (rigidity); Tremors: pill rolling; Bradykinesia; Masklike expression; Stooped posture; Hypophonia (low volume of speech); Shuffling gait; difficulty redirecting forward motion
-Nursing Diagnosis: Impaired Physical Mobility and Self-Care Deficit related to muscular rigidity, tremors, and dementia; Assist with ambulation.; Minimize fatigue; provide rest periods. Impaired Verbal Communication related to inability to articulate words; Anticipate client needs. Reduce environmental noise. Ask the client to speak slowly.

Answer 21

Parkinson’s Disease

Question 22

Shaky Movements

Answer 22

Parkinson’s Disease

Question 23

Jerky movements

Answer 23

Huntington Disease

Question 24

-Patho: Basal ganglia and portions of the cerebral cortex degenerate
-Cause: transmitted genetically and inherited by people of both genders
-S/S: Mental apathy and emotional disturbances, choreiform movements, grimacing
-Other: difficulty chewing and swallowing, speech difficulty, intellectual decline, loss of bowel and bladder control; severe depression can lead to suicide
-Advanced Huntington’s: As Huntington disease progresses, hallucinations, delusions, and impaired judgment develop due to degeneration of the cerebral cortex.
-Diagnostics: positron emission tomography (PET); genetic testing can predict which family members will develop the disease
-Medical Management: Tranquilizers and antiparkinson drugs relieve the choreiform movements. Genetic counseling before a pregnancy is advised
-Nursing Management: Client eventually becomes totally dependent on others; pneumonia, contractures, infections, aspiration of food or fluids, falls, pressure ulcers are complications

Answer 24

Huntington Disease

Question 25

-Patho: Brief episode of abnormal electrical activity in the brain
-Causes: high fever, electrolyte imbalances, uremia, hypoglycemia, hypoxia, brain tumor, drug abuse, alcohol withdrawal
-Seizure Classifications
-Partial: focal seizures, complex partial seizures
-Generalized seizures: absence, myoclonic, tonic–clonic Preictal phase, aura, status epilepticus
-S/S: Client’s motor, sensory, neurologic functions are normal except at the time of a seizure.
-Absence seizure (aka petit mal): stares blankly, eyelids flutter, lack of prominent movements
-Myoclonic seizure: sudden, excessive jerking
-Tonic–clonic seizure (aka grand mal): muscle alternate between contraction and relaxation; jerking movements
-Diagnostics: EEG, CT scan, MRI, serology, serum electrolyte levels, EGG
Medical Management
-Anticonvulsant drugs: phenytoin (Dilantin), phenobarbital, carbamazepine (Tegretol), IV barbiturates or diazepam (Valium)
-Nursing Management: Protect client from injury: Position client on his or her side; loosen restrictive clothing; airway kept patent; client is suctioned and oxygen is administered. Documentation of the situation that preceded the seizure to assist in identifying any precipitating factors or aura, duration of seizure, parts of the body involved. Vital signs, oxygen saturation, capillary blood glucose level

Answer 25

Seizure Disorders

Question 26

-Patho: Classified according to whether they are benign or malignant, type of cells involved, and the site of tumor
-Causes: viral infection, exposure to radiation, head trauma, immunosuppression
-S/S: headache (most common in the morning, becoming increasingly severe and occurs more frequently as the tumor grows), vomiting occurs without nausea or warning, papilledema, seizures, speech difficulty, paralysis, double vision
-Diagnostics: CT scan, MRI, brain scan, cerebral angiography
-Medical Management: Treated by surgery, radiation therapy, chemotherapy
-Intra-arterial or intrathecal administration, corticosteroids, osmotic diuretics, analgesics, anticonvulsants, antibiotics
-Surgical Management: craniotomy, craniectomy, radioisotopes, gamma knife radiosurgery
-Nursing Management: Support adverse effects of chemotherapy and radiation
-Teaching plan: medication regimen, appointments, nutritional support, home care, rehabilitation, referrals

Answer 26

Brain tumors