Flashcards in Nervous System Disorders Deck (98):
Questions to ask patient regarding allergies when preparing for myelogram (664)
Dye allergies.Allergies to iodine.
Signs and symptoms of ICP (715)
Restlessness, disorientation, headache, contralateral hemiparesis, ipsilaterally dilated pupil, blurred vision, diplopia.
Impaired ability to coordinate movement.
Language function is defective or absent because of injury to cerebral cortex.
Inability to carry out learned sequential movements, perform purposeful acts, or use objects.
Loss of ability to recognize familiar objects or people.
Lumbar puncture (LP) body position (703)
Side laying with knees to chest.
After myelogram procedure, what things do you need to watch for (664)
Observe puncture site for any CSF leakage.Assess strength and sensation of lower extremities.
After lumbar puncture procedure, what things do you need to watch for (662)
Assess the puncture site for drainage. Watch for development of headache. Administer bed rest, analgesics, and ice. Opioids are not helpful for LP pain.
Nursing instructions for someone having a CT scan done for the head (662)
No special physical preparation is necessary. Lay supine with head in rubber holder.
What pupillary changes are observed with ICP (668, 669)
Diplopia (double vision), weakened eye muscles, pupils rect sluggishly, ipsilateral (blown) pupil, bilateral dilation.*Blown pupils must be reported immediately.
Difficult, poorly executed speech that results from interference innervating the muscles of speech.
What data should be obtained regarding the history of migraines (666)
What treatments didn't work. Triggering factors. Signs and symptoms.
Medications for migraines (666)
ASA (Aspirin)-triptansTopiramate (Topamax)B-Blockers (-olol)SSRIs - Elavil, ProzacCa Channel Blockers - DepakoteThiazides
Foods that can trigger migraines (666)
Tyramine, nitrates, glutamates.Vinegar, chocolate, yogurt, alcohol, fermented or marinated food, ripened cheese, cured sandwich meat, caffeine, and pork.
What category of diuretics are ordered for ICP (671)
All 4 extremities are in rigid extension.*Planking
Flexion with adduction of the upper extremities, and extension with inner rotation of the lower extremities. *Pretzel spoon
Signs and symptoms of Huntington's Disease (693, 694)
Decrease in Dopamine levels. Abnormal and involuntary excessive movement (chorea). Twisting movement of the face, limbs, and body. Problems with speech, chewing, swallowing, decrease in mental cognition and emotional state, and psychotic.
Therapeutic serum range for Dilantin
Phenytoin (10 - 20 mcg/mL)
Side effects of Depakene (679)
Valproic Acid.Nausea, vomiting, indigestion, sedation, emotional disturbance, weakness, altered blood coagulation.
Nursing care for myasthenia gravis (692, 693)
Teach airway protection techniques for swallowing. Suctioning as needed. ROM exercises.
Adverse effects with taking Levadopa for Parkinson's (687)
Aggression, involuntary grimacing, head and body movements, depression, suicidal tendencies, orthostatic hypotension, nausea, vomiting, dark urine, abnormal sexual behavior.
Official diagnostic test for myasthenia gravis (692)
History and physical examination. Ask patient to look up for 2-3 minutes, observe for drooping eye lids. Other diagnostic tests are EMG and IV anti-cholinesterase.
Alternative name for Levadopa (687)
Side effects of Dilantin levels too high (toxic effects) (679)
Ataxia, vomiting, nystagmus, drowsiness, rash, fever, gum hypertrophy, lymphadenopathy.
Nursing intervention for someone who is actively seizing (679, 680)
Protection from aspiration and injury. Lower patient to the floor. Support and protect the head. Turn head to side to maintain patent airway. Observe and record observations. Note aspects of seizure. Note time for each phase, events leading up to the incident.
Postictal phase (676)
After a seizure, patient usually feels groggy and acts disoriented.
The term for slow movement associated with Parkinson's disease (684)
A client has an impairment of cranial nerve II. What should the nurse plan to do for safety specific to this impairment?
Provide a clear path for ambulation without obstacles.
Diagnostic test used for myasthenia gravis.
Levodopa (Dopar) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following would indicate that the client is experiencing an adverse reaction?
impaired voluntary movements
Which of the following symptoms are consistent with a phenytoin (Dilantin) level of 32 mg/dl?
Ataxia and confusion
When obtaining vital signs in a client with a seizure disorder, which of the following measures is used?
take an axillary instead of oral temperature
What is the priority nursing action when the nurse enters a client's room and find him/her having a seizure?
remain with client and prevent injury
To provide appropriate nursing care for a client with Multiple Sclerosis (MS), the nurse understands that this disease is characterized by:
progressive degeneration of the myelin sheath of the brain and spinal cord
Which nursing intervention is most appropriate for the grand mal seizure patient during the postictal phase?
Provide restful environment and reorient as needed
Parkinson's is a syndrome that consist of slowing down in the initiation and execution of movements is called________________.(use lower case letters only.)
Which of the following statements should the nurse include in patient teaching for a client with Multiple Sclerosis regarding activity?
They should not exercise to the point of fatigueAvoid using scatter rugs.Bed rest is indicated during an acute exacerbation
A firm diagnosis for Parkinson's disease can be made only when at least two of the three characteristic signs of the "classic triad" are present. What characteristics comprise the "classic triad"?
Which statements are accurate regarding the neurological disease, amyotrophic lateral sclerosis?
The patient remains cognitively intact throughout disease progressionIt is progressive and usually leads to death in 2 to 6 years
When taking the health history of a client admitted with a diagnosis of Huntington's disease, the nurse expects the client to answer "yes" when she asks:
"Have other family members experienced a similar diagnosis?"
The nurse is teaching a client newly diagnosed with tonic-clonic seizures the importance of observing for side effects of Valproic acid (Depakene). The nurse knows that the client needs further education when he states:
It is normal for me to have nose bleeds for one week after I start this medication.
A client is admitted to the intensive care unit (ICU) for intracranial pressure (ICP). Which one of the following diuretics will the nurse anticipate the doctor will order?
A nurse is caring for a client with amyotrophic lateral sclerosis (ALS) who has the following symptoms. What symptom requires a prompt nursing intervention?
Patient teaching for someone newly diagnosed with multiple sclerosis (683)
Space activities and avoid temperature extremes. They have a potential for emotional lability. Ensure they have the number for the nearest support group.
Classic Triad for Parkinson's disease (684)
Amyotrophic Lateral Sclerosis. Progressive neurological disease. Loss of both upper and lower motoneurons. Presents with weakness of upper extremities, dysarthria, and dysphagia. Their bodies literally waste away, and typically die from respiratory complications.
Is Huntington's disease hereditary (693)
Adverse effects of Depakote (679)
Used for generalized tonic-clonic and myoclonic seizures. A/E: Sedation, drowsiness, behavioral changes, visual disturbances, and hepatic failure.
Autonomic dysreflexia (710, 711)
Aka autonomic hyperreflexia. Typical in spinal cord injuries. Presents with severe paroxysmal hypertension and increased reflex actions. Damage to the 6th thoracic vertebrae or higher, including cervical injuries. Abnormal cardiovascular response to stimulation of the sympathetic (autonomic) nervous system. Stimulation of visceral organs results in severe bradycardia, systolic hypertension, diaphoresis, "goose flesh", flushing, dilated pupils, blurred vision, restlessness, nausea, severe headache, and nasal stuffiness. Most common cause stems from distended bladder or fecal impaction.
Spinal cord injuries that result in paraplegia (711)
T1 - T6
Wernicke's Area (659)
Temporal lobe with language comprehension. Damage to this area results in receptive aphasia.
Broca's Area (659)
Responsible for motor speech. Damage to this area results in expressive aphasia.
Global Aphasia (659)
Damage affecting both Wernicke's and Broca's Areas.
DEET Spray (705)
DEET is the primary chemical component used in insect repellent found to be very effective. Paramount in the reduction of West Nile Virus infections. Encephalopathy can occur from prolonged excessive DEET exposure.
Increased reflex reaction (hyperreflexia).
Complications of dysreflexia (712)
Age group that spinal cord injuries are most common in (710)
Men between 18 and 25 years old.
Kernig's Sign (704)
Inability to stretch the legs. Diagnostic sign for meningitis.
Brudzinski's Sign (704)
Hip and knee flexion with neck flexion. Diagnostic sign for meningitis.
Strategies to minimize pain in Trigeminal Neuralgia (701)
AKA Tic Douloureux. Minimize stimulation and use of the facial area (including drafts and touching). Can be managed with antiseizure medications, but the only cure is surgical alcohol injection into the nerve.
Primary route of infection of west nile virus (WNV) (705)
Bite from an infected female mosquito.
Medical term for inflammation of the brain (705)
Medical term for inflammation of the meninges (704)
Cranial nerve(s) involved with Bell's Palsy (701, 702)
Peripheral facial paralysis. Inflammation of cranial nerve VII (facial nerve).
Spacial awareness and body position.
12 Cranial Nerves
Spinal cord level injuries and paralysis (711)
(C1 - C3): Tetraplegia(T1 - T6): Paraplegia
Which level of spinal cord injury requires immediate action because of respiratory depression (711)
(C1 - C3): Loss of innervation to diaphragm, presents with absence of independent respiratory function.
Most common site of heterotrophic ossification
Formation of new bone: hips.
Do not over stimulate the autonomic nervous system following a spinal cord injury because which condition may develop (710)
Signs and symptoms of autonomic dysreflexia (hyperreflexia) (710)
Increased reflex actions from stimulation to the bladder, large intestine, or other visceral organs. Presents with systolic hypertension (300 mmHg), flushing, dilated pupils, severe bradycardia, diaphoresis, "goose flesh," blurred vision, restlessness, nausea, nasal stuffiness.
Spinal cord injury presents with bowel and bladder incontinence with paralysis of lower extremities (711)
(T1 - T6)
Complications of someone who has had a "brain attack," stroke (694)
Stroke resulting from thrombus, embolus, or hemorrhage. Complications include hemiparesis, inability to walk, ADL dependence, aphasia, and depression.
Disease progression for Guillian-Barre syndrome (703)
Polyneuritis presents with rapid progression. Inflammation and demyelination of the peripheral nervous system. Ab's attack Schwann cells, causing the sheath to break down. Uninsulated nerve becomes inflamed, cannot propagate an electrical charge, and resulting muscle weakness, tingling, and numbness. Disease begins at the feet and works upwards. Recovery, however, begins at the top and works downwards.
First signs of ICP (658, 715)
Best body position with increased ICP
Elevate HOB 30-45 degrees. Neck in neutral position and avoid flexion on hips, waist, and neck rotation.
Craniotomy, post-op assessment what kinds of things do you need to report to the doctor?
Signs of increased ICP.Blown pupils.
Instructions for a patient scheduled for an EEG.
Tea/coffee restricted on day of test. Test will take 45 min to 2 hours and hair should be washed the evening before the test.
What medication is used to prevent seizures during neuro surgery. Same Anticonvulsant for status epilepticus.
Fosphenytoin sodium (Cerebyx)
Alzheimer’s drugs: the first drug that was approved for moderate to severe Alzheimers.
What medication works well with spasms from spinal cord injuries.
Common side effects of antispasmodics.
Drowsiness, dizziness, disorientation, light headed ness, hypotension, urinary frequency, possible increase in blood glucose level.
Signs and symptoms and cranial nerve for Bell’s Palsy.
Cranial Nerve VIIAbrupt onset of numbness, stiffness, drawing sensation of the face, unilateral weakness of facial muscles, flaccidity of affected side, inability to wrinkle forehead as well as close eyelid, pucker lips, frown or smile.
Diuretics used for brain swelling and cerebral edema and how it works.
Which types of strokes are known as “ischemic strokes.”
Thrombotic. Most common cause of strokes.Embolic. 2nd most common cause of strokes.
Diagnostic tests used for someone suspected of brain injury.
What level of paralysis for tetraplegic.
Movement of neck and above.
Signs of late stages of ICP (669)
Rise in systolic and unchanged diastolic results in widening pulse pressure. This leads to bradycardia and abnormal respirations as late signs of increased ICP. This indicates brain herniation is imminent.
Glakow Coma Scale (GCS); normal vs. abnormal. (658)
Score for a patient not neurologically impaired is 15. The lowest possible score is 3.Any score of 8 or less is generally considered to be in a coma.
Quadraplegic have postural hypotension, how low is acceptable?
A 70 yo with back pain is scheduled to have a myelogram in the morning to rule out pathological condition of the spine. In preparing him for the procedure, what info is important to share?
He may be asked to change positions during the procedure
The nursing assessment of an 80 yo who has had a stroke found that she had difficulty swallowing. A video fluoroscopy with barium was performed to rule out aspiration. The rehab team in the SNF determined that she can eat a soft diet with one to one supervision. Which is important to prevent aspiration?
Tipping the head toward the unaffected side while swallowing.
The patient was involved in a snow mobile accident. On admission to the ER, he is receiving O2 and is incubated. His Glasgow coma scale score is 6. About 10 mins after arrival, he is noted to have a widened pulse pressure, increased systolic pressure, and bradycardia. These signs are considered an important dx sign of the late stage increased ICP. Together they are known as?
The primary goal of nursing intervention after a craniotomy is?
Prevent increased ICP
Which sign or symptom of late stage ICP should the LVN be aware of?
Increase in systolic bpWidening of pulse pressureBradycardiaUnequal pupils that react slowly to light