Ch 54: Care of Neurologic Disorders Flashcards

Questions and Answers

What is the excruciating lightning-like shock in the lips associated with?

Bell's palsy

The earliest sign of increased intracranial pressure is:

Decreasing level of consciousness (correct)

Dilated pupil

Diplopia (double vision)

Headache

A therapeutic measure to reduce increased intracranial pressure is:

Place in a semiprone position

Reduce fluid intake (correct)

Suction the patient every 2 hours

Keep the patient flat in bed

What decreases the risk of lung cancer?

Cigarette smoking Signup and view all the answers

What is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space?

Myelogram Signup and view all the answers

What is the medical term for drooping eyelid?

Ptosis Signup and view all the answers

What is the involuntary rhythmic movement of the eyes called?

Nystagmus Signup and view all the answers

Which foods may worsen headaches? (Select all that apply)

Caffeine Signup and view all the answers

The three components of Cushing's response are: (Select all that apply)

Widened pulse pressure Signup and view all the answers

Important nursing measures when feeding a hemiplegic patient include: (Select all that apply)

Checking the affected side of mouth for food accumulation Signup and view all the answers

The name of this area of the brain means 'bridge.' It is the origin of cranial nerves V through VIII and is responsible for sending impulses to the structures inferior and superior to it. It is called the

Pons Signup and view all the answers

The cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions is the

Vagus nerve Signup and view all the answers

A patient has a head injury and is presenting with signs and symptoms of increased intracranial pressure. Which nursing intervention would be helpful in reducing this pressure?

Place the neck in a neutral position to promote venous drainage Signup and view all the answers

When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient with which question?

Can you describe the sensations you are having in your head? Signup and view all the answers

A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increased intracranial pressure. What is the most significant sign or symptom of increased intracranial pressure?

Decrease in the level of consciousness Signup and view all the answers

The patient, injured in an automobile accident, is being evaluated in the emergency department for possible head injury. Which test should not be done if there is an indication of increased intracranial pressure?

Lumbar puncture Signup and view all the answers

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body?

Proprioception Signup and view all the answers

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned for her with respect to this diagnostic test?

Obtain an allergy history before the test Signup and view all the answers

A patient has recently suffered a stroke with left-sided weakness. She has problems with choking, especially when she drinks thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely?

Instructing her to tuck her chin when swallowing Signup and view all the answers

A patient's neurological status deteriorates over hours, and a craniotomy is performed to evacuate the hematoma. Which nursing intervention is indicated to help decrease the threat of increased intracranial pressure?

Elevate the head of the bed 30 degrees Signup and view all the answers

A patient has a history of tonic-clonic seizures. She was admitted to the neurological unit after having had three tonic-clonic seizures in the past 2 days. Her husband reported that she had been sleeping for long periods after each seizure. The nurse explains to him that this rest period after a tonic-clonic seizure is called a

Postictal period Signup and view all the answers

A patient has been diagnosed with organic brain pathology. He is presenting with signs and symptoms of total or partial loss of the ability to recognize familiar objects or people through sensory stimulation. This condition is called

Agnosia Signup and view all the answers

If the headaches are migraine, the nurse would expect to assess that the headaches:

They may cause unusual smells or sounds for the patient before the pain begins Signup and view all the answers

Before the patient undergoes computed tomographic (CT) scanning with a contrast medium, the nurse should

Verify that the patient is not allergic to seafood or iodine Signup and view all the answers

The Glasgow coma scale is a screening tool used to assess level of consciousness in three major areas. They are

Eye, motor, verbal Signup and view all the answers

When the seriousness of craniocerebral trauma is assessed, it is important to remember that

Signs and symptoms may not occur until several days after the trauma Signup and view all the answers

A patient, age 23, has a comminuted fracture of T6-T7. She has a spinal cord injury resulting in paraplegia. She manifests signs and symptoms of autonomic dysreflexia, which is frequently triggered by

Bladder distention Signup and view all the answers

A patient, age 52, is brought to the emergency department by ambulance after she hit her head on her bathroom sink and fell unconscious to the floor. Which assessment should the nurse perform first?

Patency of airway Signup and view all the answers

A 39-year-old mother of four has a 6-year history of multiple sclerosis. During planning, the nurse remembers this is a degenerative neurological disease that

Results from demyelination of the nerve sheath Signup and view all the answers

A patient, age 69, is being evaluated by a neurologist for signs of muscle rigidity, masklike face (area from forehead to chin), and propulsive gait. These signs are often characteristic of

Parkinsonism Signup and view all the answers

When planning care for a patient with aphasia, the nurse should

Consider the type of aphasia that the patient has and adapt communication methods accordingly Signup and view all the answers

A patient, age 27, has been admitted to the neurological department because of seizures of unknown cause. The nurse should take precautions by

Being certain padded side rails are present Signup and view all the answers

An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and 'little' strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him

From the left side Signup and view all the answers

If a patient with a head injury has drainage from the nose or ears, which nursing intervention would be appropriate?

Allow the patient to wipe the nose or ears, but not blow the nose or place anything in the external ear Signup and view all the answers

Which body system would the nurse choose to closely monitor in a patient diagnosed with Guillain-Barré syndrome?

Respiratory Signup and view all the answers

A method of reducing a person's risk of becoming infected with the West Nile virus would be to

Apply insect repellent that contains DEET Signup and view all the answers

A lumbar puncture is performed to obtain which specimen?

Cerebral spinal fluid (CSF) Signup and view all the answers

In the aging process, older adults are able to

Learn new skills Signup and view all the answers

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups. The use of intravenous immune globulin

Reduces the production of acetylcholine antibodies Signup and view all the answers

The best nursing intervention for restlessness in a patient with a head injury is

Assessing for pain or distended bladder Signup and view all the answers

In assessing a patient with suspected Bell's palsy, what clinical manifestations might be present?

Inability to wrinkle forehead and pucker lips Signup and view all the answers

Study Notes

Anatomy and Neuroanatomy

The pons connects the midbrain to the medulla oblongata and is the origin of cranial nerves V to VIII. It plays a role in respiratory regulation.
The vagus nerve innervates organs in the thoracic and abdominal cavities, stimulating peristalsis and secreting digestive juices.

Increased Intracranial Pressure (ICP)

Signs of increased ICP require the neck to be placed in a neutral position to promote venous drainage.
The earliest sign of increased ICP is a decrease in consciousness, making it crucial for monitoring.
Lumbar puncture should be avoided if there's suspected increased ICP due to risk of herniation.

Stroke Assessment and Care

A patient with stroke exhibiting left-sided weakness may have difficulty swallowing thin liquids; tucking the chin while swallowing can improve safety.
Agnosia refers to partial or total inability to recognize familiar objects, often seen in stroke patients.
When approaching a patient with hemiplegia, approach from the non-paralyzed side to maximize visual field and engagement.

Seizures

After a seizure, a patient undergoes a postictal period, often characterized by prolonged sleep and confusion.
Padded side rails are recommended for patients with frequent seizures to prevent injury.

Diagnostic Procedures

Myelography involves using radiopaque dye to visualize lesions in the spinal canal.
Prior to a CT scan with contrast, ensure the patient has no allergies to iodine or seafood as it may contain iodine.

Neurological Disorders

Agnosia can signify organic brain issues manifesting as loss of sensory recognition.
In multiple sclerosis, demyelination in brain structures leads to varying neurological symptoms and requires careful monitoring.
Parkinsonism is characterized by muscle rigidity, masklike facial expressions, and a propulsive gait.

Nursing Interventions

To alleviate restlessness in head injury patients, assess for pain or need for a change in position rather than resorting to restraints or sedation.
For autonomic dysreflexia, the most common trigger is bladder distention, necessitating prompt assessment and care.

Chronic Conditions and Aging

Older adults often retain the ability to learn, but this learning may occur at a slower pace; short-term memory is more affected than long-term memory with aging.
Myasthenia gravis involves fluctuating muscle weakness; intravenous immunoglobulin helps reduce acetylcholine antibodies.

Clinical Manifestations

In Bell's palsy, clinical signs include an inability to wrinkle the forehead or pucker the lips, resulting in facial asymmetry.
Ensuring proper patient positioning and monitoring respiratory function is essential in patients with conditions like Guillain-Barré syndrome due to paralysis risks.

Safety and Risk Factors

Avoiding cigarette smoking significantly reduces the risk of developing lung cancer.
Drainage from the ears or nose in head injury patients indicates possible meninges injury; avoid cleaning the orifice to prevent complications.### Nystagmus
Involuntary rhythmic movement of the eyes characterized by oscillations that can be horizontal, vertical, or mixed.
This eye condition is known as nystagmus.

Foods Worsening Headaches

Certain foods can exacerbate headaches, which include:
- Yogurt, as it may act as a trigger.
- Caffeine, known for its potential to worsen headache symptoms.
- Marinated foods, which can also provoke headaches.
Other common headache-inducing foods not listed include vinegar, chocolate, alcohol, and aged cheeses.

Cushing's Response

Cushing's response indicates significant changes associated with increased intracranial pressure and includes:
- Widened pulse pressure, indicating a disparity between systolic and diastolic blood pressure.
- Bradycardia, a slower heart rate that can be a reaction to increased intracranial pressure.
- Increased systolic blood pressure, reflecting the body's adjustment to rising pressure in the cranial cavity.
It serves as a critical diagnostic indicator of late-stage brain herniation.

Nursing Measures for Hemiplegic Patients

Key nursing interventions during mealtime for hemiplegic patients include:
- Checking the affected side of the mouth for food accumulation to ensure proper hygiene and prevent aspiration.
- Encouraging patients to take small bites of food to minimize choking risk.
- Adding thickening agents to liquids, which can help prevent aspiration due to swallowing difficulties.
Important to avoid mixing liquids and solids and not to remove the patient's dentures, as this can lead to choking hazards.

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Description

Test your knowledge on the care of patients with neurologic disorders through these flashcards. This set covers key concepts related to the brain structures and their functions, focusing on the pons and its significance. Perfect for nursing students or anyone studying neurology.