Neurological

Question 1

The central nervous system consists of what two components?

Answer 1

1. Brain

2. Spinal Cord

Question 2

The peripheral nervous system consists of what two components?

Answer 2

1. Cranil nerves (12)

2. Spinal nerves (31)

Question 3

The autonomic nervous system consist of what two components?

Answer 3

1. Sympathetic “flight or fight” (sweaty palms, increased HR, shaky)
2. Parasympathetic “rest and digest”

Question 4

Neurological Assessment (9)

Answer 4

• family hx (hx of MI’s, strokes, & vertigo)
• level of consciousness/orientation
• memory & attention (one of the biggest assessment features)
• sensory function (taste, feel, touch)
• cerebellar function (Rhomberg test for balance)
• cerebral function (cerebrum is the largest part of the brain & is responsible for intelligence)
• cranial nerves
• motor system
• sensory system

Question 5

Expected Findings in Aging Patients (5)

Answer 5

• decreased sensation
• decreased taste
• decrease agility & strength
• shuffled gait
• decreased cognitive ability

Question 6

Diagnostic Testing Performed to Determine Neurological Function

Answer 6

• Glasgow Coma Scale
• Lab Test (blood culture, cerebral angiography, CT scan)
• MRI
• EEG
• Lumbar Puncture

Question 7

Diagnostic test to measure of how alert & oriented the patient is.

Answer 7

Glasgow Coma Scale

• highest score is 15
• anything most (ex. sternum rub)

Question 8

Describe decorticate position. (3)

Answer 8

• inward flexion
• plantar feet
• seen post-seizure, had injuries, brain tumors

Question 9

Describe decerebrate position. (3)

Answer 9

• outward flexion
• deadly for patient
• associated w/ brain stem issues (speech, breathing, regulates temperature-hypothalamus)

Question 10

-test performed to look for specific microorganisms so that exact treatment is known

Answer 10

Blood Cultures

*drawback is length of time is takes to get results (7-10 days)

Question 11

-test performed that looks at the blood flow to the head, brain and neck (to assess if there are any blockages or strokes)

Answer 11

Cerebral angiography

*make sure to assess for allergies such as shellfish and iodine

Question 12

___ ________ are performed on patients that can not have a MRI performed.

Answer 12

CT Scans

• contrast medium causing an increased urine sensation, heart, and possible diarrhea afterwards
• Major Lab Values: BUN & Creatinine to assess kidney function
• Increase fluids with this patients!

Question 13

• Best test for neurological issues
• Patient has to remain very still during test
• contraindicated for patients with impacts and/or pacemakers

Answer 13

Magnetic Resonance Imagine (MRI)

Question 14

Electroencephalography (EEG)

• purpose
• use for dx of what
• meds to avoid
• prior to test

Answer 14

• purpose: looking at the electrical activity of cerebral hemispheres
• dx: seizures, most of the time epilepsy
• meds to avoid: CNS depressants (narcotics), seizure meds, stimulants (ex.caffeine)
• prior to test: pt needs to be woken up @ 0200 (needs to be sleep deprived) and hair must be washed before test

Question 15

A lumbar puncture is performed between _____ & _____ in the spine.

Answer 15

L4; L5

Question 16

Indications for a Lumbar Puncture (3)

Answer 16

• meningitis
• spinal cord lesions (paralyzed patients)
• pt’s with a lot of back pain
• used for diagnosis and treatment
• empty bladder before procedure
• during procedure- lateral recumbent (side-lying “fetal-like” position) and strict asepsis!!

Question 17

After a lumbar puncture is important for a patient to ______ ________ to avoid spinal leakage and horrible headache.

Answer 17

Lay flat

Question 18

-sudden, abnormal, uncontrolled electrical discharge from cerebral neurons

Answer 18

Seizure

*epilepsy- medical disorder characterized by chronic recurring abnormal brain electrical activity

Question 19

What are the two different classifications of seizures?

Answer 19

1. Partial seizures- begin in one part of the brain; simple partial->consciousness remain intact, complex partial->impairment of consciousness
2. Generalized seizures- involve the whole brain

Question 20

Causes of Seizures (6)

Answer 20

• fever (children)
• head injuries
• hypertenson
• brain tumors
• drug & alcohol withdrawal
• allergies

Question 21

Documentation of Seizure (5)

Answer 21

• length of time
• injuries
• type/movements
• what happened before the seizure
• if patient was incontinent during seizure

Question 22

Safety Measures During a Seizure (5)

Answer 22

• bed rails up (may be padded if on seizure precaution)
• bed in low position
• patient in chair->move to floor
• nothing in the mouth
• loosen restrictive clothing (if possible)

Question 23

Interventions After a Seizure

Answer 23

• side-lying position (prevent aspiration & open airway)
• vital signs
• assess for injuries
• may have to reorient patient (pt usually very lethargic)
• documentation

Question 24

Common side effect of seizure medications.

Answer 24

Gum overgrowth

-oral hygiene important

Question 25

Surgical Interventions for Seizure Patients (2)

Answer 25

1. Vagal Nerve Stimulator ("pace maker" to slow brain activity) 2. Surgical removal of brain tissue causing seizure (exact affect lobe is known, pt is awake, EEG monitoring)

Question 26

-prolonged seizure activity occurring over a 30 minute time frame

Answer 26

Status Epilepticus **#1 cause is abruptly stopping seizure medications

Question 27

Complications Associated with Status Epilepticus (2)

Answer 27

- decreased oxygen levels->brain damage | - glucose uptake->metabolic needs not being met

Question 28

Priorities of Status Epilepticus (3)

Answer 28

- airway!!! - admin meds (monitor IV patenct; usually given Ativan & Valium) - after med given, following protocol for "after a seizure" (e.g side-lying, vital signs...)

Question 29

Meningitis | -definition

Answer 29

inflammation of the membrane and the fluid space surrounding the brain and spinal cord

Question 30

Assessment Findings of Meningitis (6)

Answer 30

- fever - headache (hallmark) - neck stiffness - positive Kernig's sign - positive Brudzinski's sign - photophobia (sensitive to light)

Question 31

_____________ meningitis is contagious, however all patient are put on isolation precautions.

Answer 31

Bacterial

Question 32

Guillain-Barre - definition - recovery time - major issue

Answer 32

- demyelination of peripheral nerves (the immune system overreacts to the infection and destroys the myelin sheath) - ascending paralysis that can take 6-12 months to recover from - major issue: respiratory care (ventilator may be necessary) - associated with: acute illness, surgery, HIV

Question 33

Myasthenia Gravis

Answer 33

- progressive autoimmune disease - severe skeletal muscle weakness - insufficient secretion of acetylcholine->muscle fibers are unresponsive to acetylcholine

Question 34

Nursing Assessment of Patient with Myasthenia Gravis (3)

Answer 34

- muscle weakness (heart, respirations, incontinence, drooping eyelids) - diplopia (double vision) - difficulty chewing & swallowing *Tensilon test is performed to diagnosis this disease

Question 35

Multiple Sclerosis - definition - hallmark - 3 different types

Answer 35

- chronic demyelinating disease affecting myelin sheath of neurons in CNS - hallmark: extreme fatigue - relapsing-remitting, secondary progressive, primary-progressive

Question 36

Relapsing-remitting (MS) | -description

Answer 36

- most common (85%) | - episodes of acute worsening with recovery

Question 37

``` Secondary Progressive (MS) -description ```

Answer 37

- affects about 50% - develop in 10 years - period of doing well then get worse *meds need to be introduced

Question 38

Primary-Progressive (MS) | -description

Answer 38

- rare (approx. 10%) - slow, worsening - no relapse - patient gradually deteriorates