Chapter 61: Neurologic Dysfunction Management Quiz

Questions and Answers

What are the overarching goals of care for a patient with neurologic impairment?

Teach the family proper care of the patient

Enhance the quality of life for the patient (correct)

Achieve as high a level of function as possible (correct)

Provide community assistance

When documenting a seizure event in a patient withdrawing from alcohol, what should the nurse note?

The patient's activities immediately prior to the seizure (correct)

The success or failure of the care team to physically restrain the patient

The ability of the patient to follow instructions during the seizure

The patient's ability to explain his seizure during the postictal period

What should be the nurse's first action when assessing a patient with an altered level of consciousness (LOC)?

Assessing the patient's verbal response (correct)

Assessing the patient's judgment

Assessing the patient's response to pain

Assessing the patient's ability to follow complex commands

Which potential complications should a nurse assess for in a patient with neurologic dysfunction?

Pressure ulcers Signup and view all the answers

What medication would the nurse expect to order to reduce the edema surrounding a brain tumor?

Dexamethasone Signup and view all the answers

What is the most appropriate response when a patient with a head injury shows increased respiratory effort?

Inform the care team and assess for further signs of possible increased intracranial pressure (ICP) Signup and view all the answers

What indication of approaching death should a nurse assess for in a patient with a poor prognosis?

Loss of brain stem reflexes Signup and view all the answers

What type of seizure involves rigidity and alternating muscle relaxation and contraction?

Generalized seizure Signup and view all the answers

What nursing intervention is appropriate for a patient that developed syndrome of inappropriate antidiuretic hormone (SIADH) due to increased ICP?

Fluid restriction Signup and view all the answers

Which diagnostic procedures might be included in the admission orders of a patient scheduled for removal of an intracranial mass?

Cerebral angiography Signup and view all the answers

Which nursing action is most appropriate for a patient complaining of a headache after intracranial surgery?

Administer morphine sulfate as ordered Signup and view all the answers

What neurologic structure may have required surgery if a patient underwent transsphenoidal surgery?

Pituitary gland Signup and view all the answers

What response should the nurse have to a patient on postoperative day 1 after intracranial surgery with slightly decreased LOC?

Recognize that this may represent the peak of post-surgical cerebral edema Signup and view all the answers

How should a school nurse document a 6-year-old girl found unresponsive and 'staring into space'?

Absence seizure Signup and view all the answers

What best describes the cause of a seizure?

A dysrhythmia in the nerve cells in one section of the brain Signup and view all the answers

What medication would be expected to administer prophylactically to prevent seizures after supratentorial pituitary mass removal?

Phenytoin Signup and view all the answers

In the immediate recovery period after a seizure, what action best protects the patient's safety?

Place the patient in a side-lying position Signup and view all the answers

At what point should a patient experiencing cluster headaches take appropriate medications?

As soon as the patient senses the onset of symptoms Signup and view all the answers

What aspect of a patient's health history may contribute to recurrent headaches?

The patient takes vasodilators for treatment of angina Signup and view all the answers

Which questions should be included in assessing potential etiological factors for increased headache severity?

What medications are you currently taking? Signup and view all the answers

Increased intracranial pressure (ICP) is most commonly associated with what type of injury?

head injury Signup and view all the answers

Increased ICP may reduce _ blood flow, resulting in ischemia and cell .

cerebral, death Signup and view all the answers

Which of the following are early signs of increased ICP? (Select all that apply)

Mood lability Signup and view all the answers

Which of the following are late signs of increased ICP? (Select all that apply)

Glasgow Coma Scale of 3 Signup and view all the answers

What priority medication would be administered to a patient with cerebral edema following an acute head injury?

Hydrochlorothiazide (HydroDIURIL) Signup and view all the answers

What nursing intervention takes highest priority for an unconscious patient?

Maintaining accurate records of intake and output Signup and view all the answers

The most appropriate action for a patient with brain stem herniation and low cerebral perfusion pressure is to?

Administer osmotic diuretics as ordered. Signup and view all the answers

For a patient postoperative following a craniotomy with fluid restriction, what is an appropriate intervention?

Maintain NPO status. Signup and view all the answers

For a patient with a seizure disorder experiencing a generalized seizure, what nursing action is most appropriate?

Loosen the patient's restrictive clothing. Signup and view all the answers

In a patient on long-term phenytoin (Dilantin) therapy, what should the nurse prioritize in the care plan?

Monitoring of pulse oximetry Signup and view all the answers

What migraine medication might the nurse question for a patient with a history of acute coronary syndrome?

Sumatriptan succinate (Imitrex) Signup and view all the answers

For a patient with ineffective cerebral tissue perfusion, what outcome should the nurse document?

Obeys commands with appropriate motor responses. Signup and view all the answers

Which diagnostic tool should be used to assess a patient's level of consciousness after blunt-force trauma?

Glasgow Coma Scale Signup and view all the answers

What characteristic should the nurse assess for in the postictal state following a seizure?

Confusion Signup and view all the answers

What complication could be suspected if a patient with a ventriculostomy exhibits nuchal rigidity and photophobia?

Meningitis Signup and view all the answers

Which diagnostic test is contraindicated for a patient with increased ICP?

Magnetic resonance imaging (MRI) Signup and view all the answers

In status epilepticus, what medication may be given to halt the seizure immediately?

Intravenous diazepam (Valium) Signup and view all the answers

What early sign of increased ICP should the nurse monitor?

Loss of corneal reflex Signup and view all the answers

How should a patient following a craniotomy using the supratentorial approach be positioned?

Maintain head of bed (HOB) elevated at 30 to 45 degrees. Signup and view all the answers

What effect does alcohol have that may exacerbate migraine headaches?

Alcohol causes hormone fluctuations. Signup and view all the answers

What nursing assessment best addresses complications of diabetes insipidus after ICP increase?

Vigilant monitoring of fluid balance Signup and view all the answers

When assessing a postcraniotomy patient's urine output, what should be suspected with a urine output of 1,500 mL for two consecutive hours?

Cushing syndrome Signup and view all the answers

What actions should be implemented when a patient with a seizure disorder states they are about to have a seizure? (Select all that apply)

Ease client to floor if standing Signup and view all the answers

After a generalized seizure, which action should the nurse perform first?

Keep the client in a side-lying position Signup and view all the answers

What should be included in discharge instructions for a client prescribed phenytoin?

Take the medication at the same time every day Signup and view all the answers

What trigger factors that can cause seizures should the nurse discuss with a client with generalized seizures? (Select all that apply)

Avoid overwhelming fatigue Signup and view all the answers

What does fixed and dilated pupils in an unconscious patient indicate?

It suggests onset of metabolic problems. Signup and view all the answers

In a patient in a coma, which statement is true regarding their current level of consciousness?

The patient may occasionally make non-purposeful movements. Signup and view all the answers

When caring for a patient with permanent neurologic impairments from head injury, what mutual goal should be prioritized?

Enhance the quantity of the patient's life. Signup and view all the answers

Study Notes

Neurologic Patient Management

Mannitol (Osmitrol) is the priority medication for patients with cerebral edema to dehydrate brain tissue and reduce intracranial pressure (ICP).
Maintaining a patent airway is the highest priority nursing intervention for unconscious patients.
In cases of brain stem herniation, participate in interventions to increase cerebral perfusion pressure when ICP is low.
Monitor serum electrolytes for postoperative patients after craniotomy to address fluid volume deficiency related to diuretic use.
During a seizure, do not restrain the patient. Instead, loosen clothing and provide a safe environment.
Long-term phenytoin therapy can cause gingival hyperplasia; thorough oral hygiene is essential.
Sumatriptan succinate (Imitrex) is contraindicated in patients with a history of acute coronary syndrome due to the risk of chest pain.
An expected outcome for ineffective cerebral tissue perfusion includes the patient obeying commands with appropriate motor responses.
The Glasgow Coma Scale is used to assess the level of consciousness (LOC) in patients with blunt-force head trauma and increased ICP.
Confusion is a characteristic associated with the postictal state following a seizure.
Nuchal rigidity and photophobia may indicate meningitis, a complication of ventriculostomy monitoring.
A lumbar puncture is contraindicated in patients with increased ICP due to the risk of brain herniation.
In status epilepticus, intravenous diazepam (Valium) is administered to halt seizures immediately.
Early signs of increased ICP include disorientation and restlessness.
After craniotomy, maintain the head of the bed elevated at 30 to 45 degrees to reduce ICP.
Alcohol consumption may trigger migraines by causing vasodilation of blood vessels.
Monitor fluid balance closely in patients who develop diabetes insipidus following ICP increase.
Extreme polyuria after craniotomy suggests diabetes insipidus rather than conditions like Cushing syndrome or SIADH.
During a seizure, ensure privacy, ease the client to the floor, move furniture away, loosen clothing, and protect the head.
After a generalized seizure, the patient should be kept in a side-lying position to maintain airway patency.
Patients taking phenytoin should take medication at the same time daily to enhance effectiveness.
Trigger factors for seizures include avoiding exhaustion, limiting caffeine, and avoiding flashing lights.
Fixed and dilated pupils suggest injury at the midbrain level and are critically indicative of neurological status.
In coma states, patients may display non-purposeful movements but are generally unresponsive to stimuli.
A shared goal for patients with chronic neurological impairments is to achieve the highest possible functioning level.
Document the patient's activities leading to a seizure for insights on potential triggers and anticipatory guidance in care.### Patient Assessment
Assess verbal response by determining orientation to time, person, and place in patients with altered level of consciousness (LOC).
Evaluate the ability to follow complex commands as a part of assessing cognitive function.
Judgement assessment is crucial to understanding a patient’s decision-making capacity.
Pain response assessment is essential for evaluating neurologic function.

Complications of Neurologic Dysfunction

Common complications include:
- Contractures
- Pressure ulcers
- Venous thromboembolism (DVT)
- Pneumonia
Assess for respiratory distress or failure in patients with neurologic dysfunction.
Hemorrhage is not typically a heightened risk due to decreased LOC.

Management of Brain Tumors

Dexamethasone is preferred to reduce edema around brain tumors when increased intracranial pressure (ICP) is present.
Solumedrol and furosemide are not first-line treatments for tumor-related edema.

Head Injury Nursing Response

Increased respiratory effort following a moderate head injury may indicate rising ICP; inform the care team and assess further.
A direct bolus of fluid or repositioning may not sufficiently address the problem.

Signs of Approaching Death

Loss of brain stem reflexes, including pupillary and swallowing reflexes, indicate imminent death.
Dry mucous membranes and hemiplegia need immediate intervention but are not signs of approaching death.

Seizure Recognition

Generalized seizures can involve intense rigidity followed by alternating contractions and relaxations of muscles.
Absence seizures are characterized by brief episodes of unresponsiveness, often described as "staring into space."

Nursing Interventions for Increased ICP

Fluid restriction is the primary intervention for managing syndrome of inappropriate antidiuretic hormone (SIADH).
Monitor serum electrolyte levels to prevent complications of increased ICP like diabetes insipidus.

Diagnostic Procedures for Intracranial Surgery

Preoperative assessments may include transcranial Doppler flow studies, cerebral angiography, and MRI.
Routine cranial X-rays and electromyography (EMG) are not typically diagnostic for intracranial masses.

Postoperative Considerations

Headaches are common after craniotomies; administer morphine or appropriate pain relief as ordered.
Recognize that decreased LOC post-surgery may indicate normal cerebral edema peak rather than surgical failure.

Safety in Seizure Recovery

Position patients in a side-lying position immediately following a seizure to ensure airway clearance.
Other interventions, like padding bed rails, can complement safety but do not directly address immediate needs.

Headache Management Education

Teach patients to take abortive medications for cluster headaches at the onset of symptoms to prevent excessive pain.
Recognize that vasodilators for angina can contribute to headache occurrences.

Etiological Factors for Headaches

Explore potential contributors such as exposure to toxins, stress coping ability, current medications, and family headache history.
Hospitalization in isolation is not a likely contributor to headache onset.

Intracranial Pressure (ICP) Facts

Head injuries are the most common cause of increased ICP.
Increased ICP can reduce cerebral blood flow, leading to ischemia and cell death.
Early signs of increased ICP include behavioral changes, altered LOC, pupillary changes, and constant headaches.
Late signs may exhibit Cushing's triad, stupor, and coma, indicating severe neurologic compromise.

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Description

Test your knowledge on the management of patients with neurologic dysfunction. This quiz focuses on acute head injuries and the appropriate medications to administer, emphasizing the role of osmotic diuretics. Evaluate your understanding of critical care in the neurologic ICU setting.