Neuro 2 Flashcards
(71 cards)
1
Q
What is Meningitis?
A
Inflammation of the meninges which cover and protect the brain and spinal cord
Two Main Types: Bacterial or Viral
2
Q
How is Meningitis classified?
A
Septic caused by bacteria (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic caused by viral infection secondary to cancer or a weak immune system
3
Q
How is N. Meningitidis transmitted?
A
Secretions or aerosol contamination
Most common in dense community groups such as college campuses
4
Q
What are the clinical manifestations of Meningitis?
A
- Headache
- Fever
- Changes in LOC
- Behavioral changes
- Nuchal rigidity (stiff neck)
- Positive Kernig sign
- Positive Brudzinski sign
- Photophobia
5
Q
What is the Kernig Sign?
A
When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended
When Kernig sign is bilateral, meningeal irritation is suspected.
6
Q
What is the Brudzinski Sign?
A
When the patient’s neck is flexed, flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
Brudzinski sign is a more sensitive indicator of meningeal irritation than Kernig sign.
7
Q
What is the medical management for Meningitis?
A
- Prevention by vaccine to children 11-12 years old, booster at 16. First year college students and military
- Early administration of high dose IV antibiotic for bacterial meningitis
- Dexamethasone
- Treatment for dehydration, shock, seizures (N/V can cause dehydration)
8
Q
What are the nursing interventions for Meningitis?
A
- Frequent assessment of VS and LOC
- Pain and fever management
- Protect from injury 2/2 seizure or altered LOC
- Monitor daily weight
- Check electrolytes
- Assess urine volume, specific gravity, and osmolality (monitoring for dehydration, ⬆️ ICP, SIADH…)
- prevent complications due to immobility
- supportive care
- measures to facilitate coping of pt and family
- infection control precautions - DROPLET precautions
9
Q
What is a Brain Abscess?
A
- Collection of infectious material within brain tissue
Most common cause: bacteria
10
Q
How can you prevent a Brain Abscess?
A
- Treat Otitis Media
- Treat Rhinosinusitis
11
Q
How is a Brain Abscess diagnosed?
A
MRI or CT
CT Guided Aspiration is used to identify causative organism
12
Q
What are the clinical manifestations of a Brain Abscess?
A
- Headache that is usually worse in the morning
- Fever
- Vomiting
- Neurologic deficits
- Signs and symptoms of increased ICP
13
Q
What is the medical management of Brain Abscess?
A
- Control ICP
- Drain abscess
- Administer antibiotic therapy
- Corticosteroids to treat cerebral edema
14
Q
What are nursing interventions for patients with a Brain Abscess?
A
- Frequent, ongoing neurological assessments
- Administer medications
- Assess response to treatment
- Provide supportive care
15
Q
What is Encephalitis?
A
Acute inflammatory process of the brain tissue
16
Q
What are the causes of Encephalitis?
A
- Viral Infections (HSV) Most common cause
- Vector-Borne Viral Infections (West Nile, St. Louis)
- Fungal Infections
17
Q
What are clinical manifestations of Encephalitis?
A
- Headache
- Fever
- Confusion
- Hallucinations
- Vector-Borne: Rash, Flaccid Paralysis, Parkinson-like movements
18
Q
What is the medical management of Encephalitis?
A
- Acyclovir for HSV infection
- Amphotericin or other antifungals for fungal infection
19
Q
What is Multiple Sclerosis?
A
A progressive immune-related demyelination disease of the central nervous system
20
Q
What are some of the clinical manifestations of Multiple Sclerosis?
A
Vary with different patterns from patient to patient
- Frequently relapsing/remitting - has exacerbations and recurrences
- Fatigue (most disabling symptom)
- Weakness
- Numbness
- Difficulty in coordination
- Loss of balance
- Pain (common)
- Visual disturbances
21
Q
What is the medical management of Multiple Sclerosis?
A
Disease Modifying Therapies:
- Interferon B-1a
- Interferon B-1b
- Glatiramer Acetate
- IV Methylprednisolone
Symptom Management: muscle spasms, fatigue, ataxia, bowel and bladder control
No cure…delay progression, symptom relief
22
Q
What are some strategies to reduce the risk of aspiration?
A
- Rest before meals
- Sit upright while eating
- Eat larger meals in the morning and smaller ones at night
- Have neck slightly flexed
- Avoid thin liquids
- Semi-soft foods with thick liquids is preferred
23
Q
What is Demyelination?
A
- Destruction of myelin—the fatty and protein material that surrounds certain nerve fibers in the brain and spinal cord
- Results in impaired transmission of nerve impulses
24
Q
What are the primary goals for a patient with Multiple Sclerosis?
A
- Promotion of physical mobility
- Avoidance of falls
- Decreasing fatigue
- Development of coping strategies
- Absence of complications
- Bowel and bladder continence
- Improvement in cognitive function
- Adaptation to sexual function
25
What nursing diagnoses apply to **Multiple Sclerosis**?
* Impaired mobility associated with weakness, muscle paresis, spasticity, increased weight
* Risk for fall associated with sensory and visual impairment, lower extremity weakness
* Fatigue associated with insufficient energy
* Difficulty coping associated with uncertainty of course of MS
26
What is **Myasthenia Gravis**?
* Autoimmune disorder affecting the myoneural junction
* Antibodies directed at Acetylcholine at the myoneural junction impair transmission of impulses
## Footnote
A. Normal, B. Myasthenia Gravis
27
Who does **Myasthenia Gravis** affect most?
* It occurs more often in women during the second and third decades of life
* However, after age 50, it is more common in men
28
What are the clinical manifestations of **Myasthenia Gravis**?
* **Initially**: Ocular Muscles *(Diplopia and Ptosis)*
* Weakness of facial muscles - bland expression
* Swallowing *(dysphagia)* and voice impairment *(dysphonia)*
* Generalized weakness
*No effect on sensation or coordination.... it is purely muscular*
29
What is a **Myasthenic Crisis**?
* Disease exacerbation or precipitating event, most commonly: respiratory infection
* Severe generalized muscle weakness
* Patient may develop respiratory compromise or failure
30
What is **Guillain-Barré Syndrome**?
* Autoimmune disorder with acute attack of peripheral nerve myelin
* Most often follows a viral infection
31
What nursing diagnoses would apply to **Guillain-Barré Syndrome**?
* Impaired breathing associated with rapidly progressive weakness and impending respiratory failure
* Impaired mobility associated with paralysis
* Impaired nutritional intake associated with inability to swallow
* Impaired verbal communication associated with cranial nerve dysfunction
* Anxiety associated with loss of control and paralysis
* Fatigue associated with physical deconditioning and stressors
32
What is the medical management of **Bell's Palsy**?
Corticosteroid therapy to reduce inflammation and diminish severity of disorder
33
What are nursing interventions for the patient with **Bell's Palsy**?
* Provide information/reassurance that a stroke has not occurred
* Protection of the eye from injury: cover eye with shield at night, eye ointment, sunglasses
* Facial exercises and massage to maintain muscle tone
34
What are the clinical manifestations of **Guillain-Barré Syndrome**?
* Rapid demyelination may produce respiratory failure and autonomic nervous system dysfunction with CV instability
* Manifestations are variable
* Weakness
* Paralysis
* Paresthesia
* Pain
* Diminished or absent reflexes
* **Starts with lower extremities** and progresses upward
* Bulbar weakness *(facial muscles)*
* Cranial nerve symptoms
* Tachycardia or Bradycardia
* HTN or hypotension
35
What should be monitored in a patient with **Guillain-Barré Syndrome**?
* Changes in vital capacity and negative inspiratory force
* VS, frequently or continuously
* Continuous monitoring of ECG
* Emphasis on early detection of life-threatening complications: respiratory failure, cardiac dysrhythmias, DVT, PE, urinary retention
36
What nursing interventions can **Enhance Physical Mobility and Prevent DVT** in patients with **Guillain-Barré Syndrome**?
* Support limbs in functional position
* Passive ROM exercises at least twice daily
* Position changes Q2H
* Elastic compression stockings/ SCDs
* Adequate hydration
37
What are the primary goals for a patient with **Guillain-Barré Syndrome**?
* Improved respiratory function
* Increased mobility
* Improved nutritional status
* Effective communication
* Decreased fear and anxiety
* Effective patient and family coping
* Absence of complications
38
What is **Bell's Palsy**?
Facial paralysis caused by **unilateral inflammation** of the **7th cranial nerve** *(facial)*
39
What are clinical manifestations of **Bell's Palsy**?
* Unilateral facial muscle weakness or paralysis with facial distortion
* Increased lacrimation
* Painful sensations in the face
* Difficulty with speech and eating
## Footnote
*Often mistaken for a stroke*
40
What is the typical recovery time for **Bell's Palsy**?
3 to 5 weeks
## Footnote
*Disorder rarely reoccurs*
41
What are the different types of **Primary Brain Tumors**?
* Gliomas
* Meningiomas
* Acoustic Neuromas
* Pituitary Adenomas
## Footnote
*Classification is based on location and histologic characteristics*
42
What is an Angioma?
Mass of abnormal blood vesssels in the brain
43
How are **Brain Tumors** diagnosed?
* Neurologic examination
* CT scan
* MRI
* PET scan
* EEG
* Cytologic study of cerebrospinal fluid
* Biopsy
44
What are the clinical manifestations of a **Brain Tumor**?
* Localized or generalized neurologic symptoms
* Symptoms of increased ICP
* Headache
* Vomiting
* Visual disturbances
* Seizures
* Hormonal effects with pituitary adenoma
* Loss of hearing, tinnitus, and vertigo with acoustic neuroma
45
What should be assessed in the patient with a **Brain Tumor**?
* Baseline neurologic exam with focus on: function, mobility, weakness and paralysis, loss of vision and speech, seizures
* Pain
* Respiratory symptoms
* Bowel and bladder function
* Sleep disturbances
* Skin Integrity
* Fluid Balance
* Temperature regulation
* Family coping and family process - ask "What do you know about what is going on? What have doctors told you?" *(instead of jumping to diagnosis)*
* Nutritional status, dietary history
46
What is the medical management for a patient with a **Brain Tumor**?
**Surgery**
* Goal: removal of tumor without increasing neurologic symptoms or to relieve symptoms by decompression
* Craniotomy, transsphenoidal surgery, stereotactic procedures
**Radiation Therapy**
* Cornerstone of treatment for many brain tumors
**Chemotherapy**
**Pharmacologic Therapy**
47
What are the primary goals for a patient with a **Brain Tumor**?
* Compensate for self-care deficits
* Improve nutrition
* Reduce anxiety
* Enhance family coping skills
* Absence of complications
48
What are the nursing interventions for patients with a **Brain Tumor**?
* Encourage independence for as long as possible
* Measures to improve cognitive function
* Measures to improve nutrition
* Allow patient to participate in decision making
* Allow patient to express fears and concerns
* Presence of family, friends, spiritual advisor, health care personnel may be supportive
* Referral to counselor, social worker, home health, support groups
* Referral to hospice care
49
What nursing interventions can help **Improve Nutrition** for patients with **Brain Tumors**?
* Oral hygiene before meals
* Plan meals for times when patient is comfortable and well rested
* Measures to make meal times as pleasant as possible
* Dietary supplements
* Offer preferred foods
* Daily weights
* Record dietary intake
50
What is **Parkinson's Disease**?
* A slow progressive neurologic movement disorder
* Associated with decreased levels of dopamine
51
What are the clinical manifestations of **Parkinson's Disease**?
* Tremor
* Rigidity
* Bradykinesia/Akinesia
* Postural Instability
* Sweating
* Drooling
* Flushing
* Orthostatic Hypotension
* Gastric and Urinary Retention
* Dysphagia
* Psychiatric Changes: Depression, anxiety, dementia, delirium, hallucinations
52
What should be assessed in the patient with **Parkinson's Disease**?
* Degree of disability
* Responses to medications
* Quality of speech, facial expression
* Swallowing deficits
* Tremors, slowness of movement, weakness
* Forward Posture
* Rigidity
* Mental slowness or confusion?
* Fall risk assessment
* ADLs
53
What is the medical management of **Parkinson's Disease**?
**Levodopa-Carbidopa** *(most effective treatment)*
* Levodopa converts to dopamine
* Carbidopa inhibits metabolism of levodopa
* Therapeutic mostly in first 1-2 years
* Within 5-10 years, patients develop dyskinesia
**Surgical procedures**
**Stereotactic procedures**
* Thalamotomy
* Pallidotomy
*These are ablative procedures that were formerly used to relieve symptoms. They permanently destroy brain tissue and are rarely used today*
**Deep Brain Stimulation**: Used more often than sterotactic procedures now.
**Neural Transplantation**
* Ongoing research...
54
What is **Huntington Disease**?
* Chronic, progressive, hereditary disease that results in choreiform movement *(Involuntary movement)* and dementia
* **Autosomal Dominant Trait**
* Premature death of cells in the striatum of the basal ganglia *(control of movement)* and cortex *(thinking, memory, perception, judgment)*
55
What is **Amyotrophic Lateral Sclerosis (ALS)**?
AKA Lou Gehrig Disease
* Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of the lower brainstem
56
What are the clinical manifestations of **Amyotrophic Lateral Sclerosis**?
* Progressive weakness and atrophy of muscle
* Cramps
* Twitching
* Lack of coordination
* Spasticity
* Deep Tendon Reflexes are brisk and overreactive
* Difficulty speaking, swallowing, and breathing
57
What are **Muscular Dystrophies**?
* Incurable disorders characterized by progressive weakening and wasting of skeletal and voluntary muscles
* Most are inherited disorders
58
What is the most common type of Muscular Dystrophy?
Duchenne Muscular Dystrophy
## Footnote
Inherited as a sex-linked trait
59
What are common characteristics of **Muscular Dystrophies**?
* Varying degrees of muscle wasting and weakness
* Elevated serum levels of muscle enzymes
60
What is the typical treatment for **Degenerative Disc Disease**?
Conservative: Rest and medication
61
What is **Degenerative Disc Disease**?
Degenerative changes to the vertebral discs related to aging or trauma
Causes back/neck pain, changes in sensation and motor responses
## Footnote
This is the cause of most back pain
62
Where do most herniations of vertebral discs occur?
L5 - S1 Lumbar Spine
63
What do herniated discs of the lumbar spine lead to?
* Low Back Pain
* Sciatica *(shooting/radiating pain down one leg)*
* Alterations in spine mechanics *(trying to avoid pain)*
* Muscle weakness
* Alterations in tendon reflexes
* Loss of sensation to one or both extremities
64
How are herniated discs diagnosed?
* Based on History and Physical Exam
* CT
* MRI
* Myelography
65
What is the medical management of **Lumbar Disc Disease**?
* Muscle relaxants
* NSAIDs
* Systemic Corticosteroids
* Weight Reduction
* Physical Therapy/Exercise
* Biofeedback
**Surgery:**
* Lumbar Laminectomy, discectomy, microdiscectomy
**Myelography**
66
What are nursing interventions for **Lumbar Disc Disorder**?
* Provide pre- and post- operative care
* Neurologic and pain assessments
* Positioning
* Educate on self-care: increase activity gradually, rest periods, no heavy work for 2-3 months, exercises to strengthen ab muscles, back brace if pain persists
67
What position should a patient be in if they are having increased intracranial pressure?
**Semi-fowlers (30° - 45°) or higher**
68
What are some medications to treat **Parkinson's Disease**?
**Anticholinergics:**
* Benztropine mesylate
* Trihexyphenidyl hydrochloride
**Antiviral:**
* Amantadine hydrochloride
**Dopamine Agonists:**
* Bromocriptine mesylate pergolide
**Nonergot Derivatives:**
* Ropinirole hydrochloride
* Pramipexole
**MAO Inihibitors:**
* Selegiline rasagiline
**Catechol-O-Methyltransferase Inhibitors**
* Entacapone
* Tolcapone
69
**What is a positive Kernig Sign?**
**a.** Extreme sensitivity to light
**b.** Any attempts at flexion of the head are difficult because of spasms in the muscles of the neck
**c.** When the patient is lying with the thigh flexed on the abdomen, the leg cannont be completely extended
**d.** When the patient's neck is flexed, flexion of the knees and hips is produced, when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
**c. When the patient is lying with the thigh flexed on the abdomen, the leg cannont be completely extended**
**Rationale:**
Photophobia is common with meningitis and is extreme sensitivity to light.
Rigidity is any attempt at flexion of the head being difficult because of spasms in the muscles of the neck.
Brudzinski's sign is when the patient's neck is flexed, flexion of the knees and hips is produced, and when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
## Footnote
***Kernig sign is indicative for Meningitis, but Brudzinski's sign is more sensitive for it.***
70
**What is a common type of brain tumor of the brainstem?**
**a.** Astrocytoma
**b.** Neuroma
**c.** Pineocytoma
**d.** Pineoblastoma
**a. Astrocytoma**
**Rationale:**
Astrocytoma is a common brain tumor of the brainstem, corpus callosum, cerebrum, cerebellum, and optic chiasm.
Neuroma is a common brain tumor of the acoustic nerve
Pineocytoma and pineoblastoma are common brain tumors of the pineal area
71
**What is an anticholinergic medication used to treat Parkinson's Disease?**
**a.** Benztropine Mesylate
**b.** Diphenhydramine Hydrochloride
**c.** Orphenadrine citrate
**d.** Phenindamine hydrochloride
**a. Benztropine mesylate**
**Rationale:**
Benztropine is an anticholinergic used to control tremor and rigidity and counteracts the action of acetylcholine with Parkinson's Disease.
Diphenhydramine hydrochloride, orphenadrine citrate, and phenidamine hydrochloride are antihistamines that may reduce tremors
