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NUR 3020 exams > disorders of the CNS/PNS > Flashcards

disorders of the CNS/PNS Flashcards

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1
Q

what is meningitis (what, classified, observe for (2))

A

inflammation of the meninges, specifically the arachnoid and Pia mater
- classified by: septic (bacterial), aseptic (viral)
- observe for signs of direct communication to the CNS: otorrhea (ear drainage), rhinorrhea (nasal drainage)

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2
Q

viral meningitis (ASEPTIC) (common/uncommon?, no _____ found in CSF culture, causes (3), _____ _______ more likely to be temp…, treatment?)

A
  • most common type
  • no organisms found from the CSF culture
  • causes: viral, s/d cancer, weakened immune system (HSV-2, VZV, mumps, HIV)
  • neuro deficits more likely to be temporary and full recovery occurs as the inflammation resolves
  • treatment: administration of antiviral agents (via IV to cross blood brain barrier)
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3
Q

bacterial meningitis (SEPTIC) (common/uncommon, fairly high ________…, causes (2), highly _____________, occurs where?

A
  • MEDICAL EMERGENCY!!!
  • fairly high mortality rate, often within 24 HOURS
  • causes: streptococcus pneumoniae, Neisseria meningitidis
  • highly contagious
  • occurs in areas of high population density (first year college students, military, prisons)
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4
Q

what are the increased risk of bacterial meningitis (4)

A
  • tobacco use, upper respiratory viral infection (d/t increased amount droplet production
  • otitis media + mastoiditis (d/t increased risk bacterial meningitis can cross epithelial membrane and enter subarachnoid space)
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5
Q

s/sx meningitis (12)

A
  • headache (steady, throbbing, very severe)
  • fever
  • photophobia (sensitive to light)
  • nuchal rigidity (stiff neck d/t neck muscle spasms)
  • myalgia (muscle aches)
  • N/V
  • confusion/altered LOC
  • rash
  • positive kernig sign
  • positive brudzinski’s sign
  • seizures (d/t irritability of brain)
  • increased ICP (s/d diffuse brain swelling)
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6
Q

positive kernig sign

A

when patient lying with thigh flexed on abdomen, leg won’t completely extend
- B/L = meningeal irritation suspected

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7
Q

positive brudzinski’s sign

A

when patient neck flexed, flexion of knee and hip produced
- when LE passively flexed, similar movement seen on opposite extremity

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8
Q

what are signs of increased ICP (2)

A

decreased LOC
focal motor deficits

(if not attended to): pressure on brain stem -> brainstem herniation -> life threatening event (causes cranial nerve dysfunction + depresses center of vital functions + medulla)

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9
Q

meningitis nursing interventions (7)

A
  • prevention is KEY (vaccination: meningococcal conjugated vaccine, hand washing)
  • monitoring neurological status
  • give broad spectrum antibiotics ASAP and dexamethasone (inflammation), anticonvulsants for seizures, fluid volume expanders for dehydration/shock
  • monitor vascular status
  • maintain droplet precautions for bacterial meningitis (mode of transmission)
  • pain management PRN
  • maintain a quiet, cool, dark room for comfort
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10
Q

encephalitis (what, cause, can be _____ ________ or lead to _______ such as ____(4), ______ _______ causes _______ ____ ________ _______ -> further increase in _____ and potentially death)

A

inflammation of brain issue that affects cerebrum, brainstem, and cerebellum, and surrounding meninges
- cause: viral agent HSV (herpes simplex virus)
- can be LIFE THREATENING or lead to persistent neurological problems (d/t swelling of brain tissue) -> learning disabilities, epilepsy, memory deficits, fine motor deficits
- widespread edema causes compression of blood vessels -> further increase in ICP and possibly death

(local necrotizing hemorrhage that becomes more generalized, followed by edema. Progressive deterioration of nerve cell bodies)

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11
Q

encephalitis nursing interventions (3)

A
  • Prevention is KEY (wear protective clothing in mosquito infested areas)
  • pharmacological: acyclovir (Zovirax), ganciclovir (cytovene) for HSV encephalitis ASAP, pain management (analgesic agents)
  • supportive care: dimming lights, limit noise, ABC’s, educate families, control temp, neuro Q4H

TIP: monitor blood chemistry test results and urinary output (alerts nurse presence of renal complications r/t antiviral therapy)

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11
Q

what is demyelination (what, results in)

A

destruction of myelin - fatty and protein material that surrounds certain nerve fibers in brain and spinal cord
- results in impaired transmission of nerve impulses

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11
Q

multiple sclerosis (what, leading causes of?, characterized by, affects (6), causes ______ and ______ damage?)

A

lifelong inflammatory disease causing demyelination and axonal injury of unknown etiology that affects the brain and spinal cord (affects myelin sheath of CNS -> interrupted transfer of messages
- leading causes of neurological disabilities in young adults
- characterized by periods of remission and exacerbation aka relapsing remitting course
- affects: optic nerves, chiasm, tracts, cerebrum, brainstem, spinal cord
- causes permanent and irreversible damage

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11
Q

encephalitis s/sx (14)

A
  • high fever
  • N/V
  • stiff neck (nuchal rigiditiy)
  • changes in mental status
  • motor dysfunction
  • hallucinations
  • photophobia
  • fatigue
  • increased ICP
  • behavioral changes
  • joint pain
  • headache
  • vertigo
  • focal seizures
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11
Q

s/sx multiple sclerosis (18)

A
  • muscle weakness and spasiticity
  • fatigue
  • intention tremors
  • dysmetria (inability to perform accurate, smooth movements)
  • numbness/tingling sensations
  • hypalgesia (decreased sensitivity to painful stumuli)
  • ataxia (impaired coordination)
  • dysarthria (slurred speech)
  • dysphagia (difficulty swallowing)
  • diplopia (double vision)
  • nystagmus (rapid involuntary eye movement)
  • scotomas (blind spots)
  • decreased visual and hearing acuity
  • tinnitus/vertigo
  • bowel/bladder dysfunction
  • cognitive changes
  • depression
  • alterations in sexual function
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12
Q

multiple sclerosis nursing interventions (goal, 7)

A

Goal: delay progression of disease, manage chronic sx., treat acute exacerbations
- preventing exacerbations
- managing symptoms (rest)
- improve function
- enhance bladder and bowel control (antispasmodics - baclofen, anticholinergics - seroquel, alpha adrenergic blockers - coreg, tamsulosin)
- complementary and alternative therapies
- pharmacological: immunomodulators, anti-inflammatory, steroid, daily analgesic

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13
Q

myasthenia gravis (what, may take many _____ -> ?, types)

A

progressive and acquired autoimmune disease characterized by muscle weakness caused by distorted acetylcholine receptors (AChRs) in the muscle motor end plate membranes
- may take many forms -> mild disturbances of the cranial and peripheral motor neurons to a rapidly developing, generalized weakness that may lead to death from respiratory failure
- 2 types: ocular (affects eyes), generalized (affects other systems)

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14
Q

MG classes (5)

A

1) class 1: any ocular weakness, may have weakness of eye closure; all other muscle strength is normal
2) class 2: mild weakness affecting other than ocular muscles; may also have ocular weakness
3) class 3: moderate weakness affecting other than ocular muscles; may also have ocular weakness
4) class 4: severe weakness affecting other than ocular muscles; may also have ocular weakness
5) class 5: defined by the need for intubation (except when used during routine postoperative management)

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15
Q

myasthenia gravis s/sx (7)

A
  • progressive muscle weakness that worsens with repetitive use and usually umproves with rest
  • fatigue
  • poor posture
  • ocular palsies (decrease muscle strength), ptosis (drooping eyelids), incomplete eyelid closure, diplopia (double vision)
  • dysphagia, voice weakness
  • loss of bowel/bladder control
  • respiratory complications
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16
Q

the tensilon test (what)

A

pharmacologic tests with the cholinesterase inhibitors edrophonium chloride (tensilon) and neostigmine bromide (prostigmin) may be performed
- drug INHIBITS breakdown of ACh at postsynaptic membrane, which increases availability of ACh for excitation of postsynaptic receptors
- 2mg IVP then 8mg IVP after 30 seconds
- within 30-60 seconds, most MG patients show a marked improvement in muscle tone that lasts up to 5 minutes

GOLD STANDARD FOR DIAGNOSIS OF MG

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17
Q

cholinergic crisis (MG)

A

when patient receives TOO MUCH cholinesterase inhibitor drugs (too much ach available)
- tensilon will actually increase weakness and fasciculations around the eyes and face may be seen (HOLD ALL ANTICHOLINERGIC MEDS)

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18
Q

cholinergic crisis s/sx (10)

A

(SLUDGE)
- salivation
- lacrimation
- urination
- diarrhea
- gastrointestinal distress (cramping)
- emesis

  • excessive bronchial mucus production and secretion, miosis (pupils constrict), skeletal muscle spasms/fasciculations
  • bradycardia
  • respiratory failure, flaccid paralysis
  • death CAN OCCUR
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19
Q

cholinergic crisis treatment (2)

A
  • anticholinergics (eg. atropine)
  • benzodiazepines (eg. diazepam)
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20
Q

myasthenia crisis (what)

A

when the patient DOES NOT GET ENOUGH cholinesterase inhibitor drug (too little ACh)
- worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation
- tensilon will result in improved muscle strength

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21
myasthenia crisis s/sx (6)
- generalized weakness - severe bulbar (oropharyngeal) weakness - mydriasis (dilated pupils) - tachycardia - respiratory failure - death CAN OCCUR
22
myasthenia crisis treatment
- neuromuscular agent (neostigmine) to increase muscle tone and treat MG
23
myasthenic (6) vs. cholinergic crisis (7) vs. both (6)
myasthenic: - increased pulse and respiration - rise in BP - bowel/bladder incontinence - decreased urine output - absence of cough and swallow reflex - IMPROVEMENT of symptoms with TENSILON TEST cholinergic: SLUDGE - flaccid paralysis - hypersecretion - n/v/d - abdominal cramps - miosis, blurred vision - pallor - WORSENING of symptoms with TENSILON TEST both: - apprehension - restlessness - dyspnea - dysphagia - generalized weakness - respiratory failure
24
myasthenia gravis nursing interventions (6 including pharmacological (5)
- respiratory support: manually assisted coughing, pulmonary hygiene, suctioning, oral care - plasmapheresis (plasma exchange) or IVIG (IV immunoglobulins) - improving function: energy conservation s/sx - surgery: life long circulatory t cells - supportive care: mobility aids, prevent dysphagia, energy conservation pharmacological: - anticholesterases/cholinesterase inhibitors (pyridostigmine) - cholinergic drugs - immunosuppressive drugs - corticosteroids - plasmapheresis
25
plasmapheresis (what, side effects (8))
removes circulatory antibodies thought to be responsible for the disease - plasma is selectively separated and removed from white blood - 3-4 treatments but may require a second round - nurses must weigh the patients before and after the procedures and care for the shunt/line side effects of plasmapheresis: - citrate-induced hypocalcemia - urticarial reactions (skin reaction that causes itchy welts/hives) - depletion coagulopathy (blood can't coaguate) - immunoglobulin depletion ( - risk for infection (sepsis through single line) - fluid shift or depletion - sensitivity reactions - site specific complications
26
IV immunoglobulins (IVIG) (what, side effects (2))
contains pooled immunoglobulin G (IgG) immunoglobulins from the plasma of approximately a thousand or more blood donors side effects of IVIG: - minor discomforts (chills, mild fever, myalgia, headache) - major complications (anaphylaxis, aseptic meningitis, retinal necrosis, acute renal failure)
27
guillan barre syndrome (what, result of, antibodies attack?, leads to, healing occurs in _____)
- acute inflammatory polyradiculoneuropathy that affects the axons and/or myelin of the peripheral nervous system, causing motor weakness and abnormalities in sensory perception - result of IMMUNE MEDIATED PATHOLOGY - antibodies attack the myeline sheath that surrounds the axon of the peripheral nerves - leads to acsending paralysis: progressive motor weakness starting in legs and spread upwards (respiratory failure) - healing occurs in the REVERSE
28
acute guillain barre syndrome stages (3)
1) stage 1: acute or initial phase (1-4 weeks) - begins with onset of first symptoms, ends when no further deterioration occurs 2) stage 2: the plateau period (several days - 2 weeks) - healing through interventions 3) stage 3: the recovery phase (4-6 months to 2 years) - thought to coincide with remyelination and axonal regeneration
29
chronic guillian barre syndrome stages
some patient do NOT completely recover and have permanent neurologic deficits
30
guillian barre syndrome s/sx motor (5)
motor manifestations - ascending symmetric muscle weakness -> flaccid paralysis without muscle atrophy - decreased or absent DTRs - respiratory compromise (dyspnea, diminished breath sounds, decreased tidal volume, reduced SpO2, respiratory failure) - loss of bowel/bladder control - ataxia
31
guillian barre syndrome s/sx sensory (2)
- parasthesia - pain (cramping)
32
Guillian barre syndrome s/sx cranial nerve manifestation (4)
- facial weakness - dysphagia - diplopia - difficulty speaking
33
guillian barre syndrome s/sx autonomic manifestations (3)
- labile BP - cardiac dysthymias - tachycardia
34
guillian barre syndrome nursing interventions (7)
- airway management - plasmapheresis or IVIG - develop similar communication techniques - referrals: physical and occupational therapy, speech language pathologist, dietician - perform passive ROM exercises Q2-Q4 - VTE prophylaxis - pharmacological: pain med, opioids, gabapentin, TCA (tricyclics)
35
trigeminal neuralgia (what, _____ nature of pain, associated with?)
tic douloureux - chronic pain syndrome characterized by paroxysms of sudden pain in the area innervated by any of the three branches of the fifth cranial nerve - unilateral nature of pain - associated involuntary contraction of the facial muscles can cause sudden closing of the eye or twitching of the mouth, hence the former name tic douloureux (painful twitch) can affect any/all nerves *mainly 3, not BL
36
trigeminal neuralgia assessment (3)
1) sudden intense facial pain (spasm like) - excruciating, sharp, shooting, piercing, burning, jabbing pain (jaw, mandibular division, occular) 2) usually provoked by minimal stimulation of a trigger zone 3) unilateral and confined to the area innervated by the trigeminal nerve
37
trigeminal neuralgia nursing interventions (3, pharmacological (4))
pharmacological: anticonvulsant - AED: carbamazepine (tegretol) - gabapentin (neurontin) - pregabalin (lyrica) - baclofen (lioresal) - acupunture - surgery (help with neurovascular decompression, radial frequency, thermoregulation) RISK: infection!
38
bell's palsy (what, cause, remission?)
(facial paralysis) unilateral inflammation of the 7th cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side - cause: inflammation triggered by a formerly dormant HSV-1 (cyclivir) - most patients go into remission within 3 months
39
bells palsy s/sx (6)
- paralysis over 2-5 days on one side - pain - cannot close the eye, wrinkle forehead, smile, whistle, grimace - tearing may stop or become excessive - impaired taste - tinnitus
40
bells palsy nursing interventions (3, pharmacological 4)
pharmacological: - corticosteroids - antivirals - mild analgesics - artificial tears - warm/moist heat - massage/exercise
41
brain tumor (what, effects, type of changes resulting in _______(4))
occupies space within the skull, growing as a spherical mass or diffusely infiltrating tissue - effects of brain tumors are caused by inflammation, compression, and infiltration of tissue - a variety of physiologic changes result, causing any or all of the following: increased intracranial pressure (ICP) or cerebral edema, seizure activity and focal neurological signs, hydrocephalus, altered pituitary function
42
cerebral tumors s/sx (9)
- headache - vomiting unrelated to food intake - changes in vision, diplopia - hemiparesis or hemiplegia - hypokinesia: diminished motor activity - hyperesthesia (hyper sensitive to stimuli), paresthesia (pins and needles), decreased tactile discrimination - seizures - aphasia - changes in personality or behavior
43
brainstem tumors s/sx (9)
(lower functioning) - hearing loss (acoustic neuroma) - facial pain and weakness (CN 5 or trigeminal neurlgia) - dysphagia, decreased gag reflex (CN 9) - nystagmus: rapid involuntary eye movement - hoarseness - ataxia or dysarthria (cerebellar tumors): difficulty speaking d/t weak muscles - apnea: stop breathing - bradycardia - hypotension
44
brain tumor nursing interventions (5, pharmacological (4))
- surgery - radiation - assist the patient in compensating for self care deficits (ROM, feeding) - improve nutrition (potential nutrition supplementation - protein, lipids, carbs, etc.) pharmacological: - chemotherapy: to control tumor growth or decrease tumor burden (doesn't last) - analgesics: given for headache (NSAIDs, steroids, antiepileptic) - steroids: given to control cerebral edema (Dexamethasone - decadron) - AEDs: to prevent or treat seizures
45
parkinson disease (what, 4 cardinal signs)
progressive neurodegenerative disease as a result of DOPAMINE LOSS in the brain - debilitating disease affecting motor ability and is characterized by four cardinal symptoms: 1) tremors 2) muscle rigidity 3) bradykinesia/akinesia 4) postural instability - reduces sympathetic nervous system: influences heart and blood vessels
46
parkinson disease stages (5)
1) stage 1 (initial stage) - unilateral limb movement, minimal weakness, hand and arm trembling 2) stage 2 (mild stage) - bilateral limb involvement, masklike face, slow and shuffling gait 3) stage 3 (moderate stage) - postural instability, increased gait disturbances 4) stage 4 (severe stage) - akinesia, rigidity 5) stage 5 (complete ADL dependence_
47
parkinson disease s/sx (posture (2), gait (5), motor (12))
1) posture: stooped posture, flexed trunk 2) gait: slow, shuffling, short hesitant steps, propulsive gait, difficulty stopping quick 3) motor: - bradykinesia - muscular rigidity - akinesia - resting tremors - "pill rolling" movement - mask- like face - difficulty chewing and swallowing - uncontrolled drooling - fatigue - difficulty changing positions - reduced arm swing on one side of the body when walking - micrographia (small handwriting effects)
48
parkinson disease s/sx (speech (5), autonomic dysfunction (7), psychosocial (8))
4) speech: soft, low pitched voice, dysarthria, echolalia, hypophonia 5) autonomic dysfunction: orthostatic hTN, excessive perspiration, oily skin, seborrhea, flushing, changes in skin texture, blepharospasm (twitching eye) 6) psychosocial: emotionally labile, depressed, paranoid, easily upset, rapid mood swings, impaired cognition (dementia/delirium), delayed reaction time, sleep disturbances
49
parkinson disease nursing interventions (5, pharmacological (2))
pharmacological: 1) dopamine agnosits: mimics dopamine by stimulating dopamine receptors in brain (apormorphine - apokyn, pramipezole (mirapex), ropinirole (requip), rotiigotine (neupro) 2) levodopa: better at improving motor function but LT use leads to dyskinesia (decreased motor movement) - improve mobility and enhance self care activities (safety, assisted devices ambulation, change position slowly, dysphagia precautions) - improve nutrition and elimination - maintain safety precautions - supportive care
50
huntington disease (what, 3 stages)
hereditary autosomal dominant disorder (gene mutation on one of the chromosome associated with that pair, 50% inheritance) that causes both neurological and behavioral symptoms that usually begin between ages 30-50 and progressively worsens 3 stages - 1) stage 1: onset of neurological or psychological symptoms 2) stage 2: characterized by an increasing or dependence on others for care 3) stage 3: loss of independent function
51
huntington's disease s/sx (8)
- dominant inheritance - choreiform movements (rapid jerky movements) in limbs trunk and facial muscles - progressive mental status changes leading to dementia - poor balance - hesitant or explosive speech - dysphagia - impaired respirations - bowel/bladder incontinence
52
huntington disease nursing interventions (5, pharmacological (2))
- no known treatment or cure for HD - genetic counseling - supportive care - end of life care pharmacological: - tetrabenazine (xenazine) to help with chorea movements - benzodiazepines and neuroleptic drugs may also help with chorea
53
amyotrophic lateral sclerosis (what, begins ____, ______ typically occurs within ___ years of diagnoses d/t _______ ________)
(Lou Gehrig's disease) - upper and lower motor neuron disease that is characterized by progressive weakness, muscle wasting, and spasticity that eventually leads to paralysis - begins in one area of the body -> motor weakness and deterioration spread until the entire body is involved includes ability to talk, swallow, and breathe - death typically occurs within 3 years of diagnoses d/t respiratory failure
54
amyotrophic lateral sclerosis assessment (early clinical manifestations) (11)
- tongue atrophy - weakness of hands and arms - beginning of muscle atrophy of arms - fasciculations of face or tongue - difficulty controlling crying or laughing - nasal quality of speech - dysarthria - dysphagia - fatigue while talking - stiff or clumsy gait - abnormal reflexes
55
amyotrophic lateral sclerosis assessment (late clinical manifestations) (4)
- muscle atrophy (typically in trapezius, sternocleridomastoid muscles) - respiratory depression - pneumonia: can't clear seizures appropriately - death
56
amyotrophic lateral sclerosis nursing interventions (5, pharmacological (2)
- no prevention, no treatment, no cure - symptomatic treatment - supportive care - end of life care (pallative, hospice) pharmacological: - riluzole and edarav one can possibly extend survival time 3-6 months

NUR 3020 exams (11 decks)

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