Neurological Disorders Assessment Quiz

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Questions and Answers

What percentage of the global burden of disease is constituted by neurologic disorders?

12% (correct)

20%

14%

Which of the following is NOT included in the health history assessment for neurological disorders?

Medications

Family history

Blood pressure readings (correct)

Allergies

What is one of the components assessed during a neurologic examination?

Nutritional status

Gait, stance, and coordination (correct)

Respiratory rate

Visual acuity

What is the maximum score obtainable on the Glasgow Coma Scale?

15 Signup and view all the answers

Which aspect of the Glasgow Coma Scale assesses the best motor response?

Localized pain Signup and view all the answers

What type of symptoms might indicate a disturbance in the gastrointestinal system in neurological disorders?

Nausea and vomiting Signup and view all the answers

Which of the following symptoms is associated with disturbances in the nervous system?

Weakness Signup and view all the answers

What component of the Glasgow Coma Scale represents a score of 6?

Obeys command Signup and view all the answers

What major complaint should the nurse anticipate in a patient post-surgery?

Sore throat Signup and view all the answers

Which action should NOT be taken if a patient develops a sore throat post-operation?

Administer numbing spray Signup and view all the answers

What should the postoperative patient be monitored for regarding physical condition?

Change in blood pressure Signup and view all the answers

After surgery, how long should the patient remain flat in bed?

12 - 24 hours Signup and view all the answers

Which of the following is an appropriate intervention for a patient who has undergone cervical surgery?

Use a cervical collar Signup and view all the answers

What position should be avoided while the patient is sleeping post-surgery?

Prone position Signup and view all the answers

What should the patient do if they experience increased pain postoperatively?

Immediately contact their healthcare provider Signup and view all the answers

What type of diet may be recommended for a patient complaining of dysphagia post-operation?

Soft diet Signup and view all the answers

What is the significance of a GCS score between 3 and 8?

Indicates severe head injury Signup and view all the answers

Which imaging technique involves injecting a contrast medium to visualize cerebral circulation?

Cerebral Angiography Signup and view all the answers

What is the purpose of a PET scan combined with a CT scan?

To create a clearer image for interpretation Signup and view all the answers

What type of anesthesia is typically used for a lumbar puncture?

Local anesthesia Signup and view all the answers

What is a common finding in normal cerebrospinal fluid (CSF) analysis?

Clear appearance Signup and view all the answers

Which condition could contraindicate a lumbar puncture?

Increased intracranial pressure Signup and view all the answers

What does an Electroencephalogram (EEG) record?

Electrical activity of the brain Signup and view all the answers

Which type of disc herniation is the rarest?

Thoracic Signup and view all the answers

Which of the following symptoms is NOT commonly associated with cervical issues?

Lower back pain Signup and view all the answers

What imaging technique is commonly used to evaluate spine disorders?

X-ray Signup and view all the answers

Which of the following indicates a preparation for surgical intervention?

Significant neurological deficit Signup and view all the answers

What is the primary focus of discharge planning for a patient with lumbar spine issues?

Promote proper posture and lumbar flexion exercises Signup and view all the answers

What is a common non-surgical treatment method for muscle spasm control?

Cervical traction Signup and view all the answers

What condition may result in chronic back and leg pain after spinal surgery?

Failed disc syndrome Signup and view all the answers

In which scenario is a laminectomy most indicated?

Ruptured disc causing neurological symptoms Signup and view all the answers

Which practice should be avoided to prevent exacerbating cervical spine issues?

Excessive automobile riding during acute phase Signup and view all the answers

Study Notes

Neurological Disorders and Intervertebral Disk Prolapse

Neurological diseases are common and costly, affecting over 1 billion people worldwide, accounting for 12% of the global disease burden and 14% of global deaths.

Introduction

Neurologic diseases are common and costly.
Neurological disorders affect over 1 billion people worldwide.
They constitute 12% of the global burden of disease.
They cause 14% of global deaths.

Neurological Assessment

Health History: Includes details about the patient's chief complaint, onset, signs and symptoms, predisposing factors, aggravating and relieving factors, medications, alcohol and recreational drug use, and any history of head or spinal cord trauma or falls. Also, allergies, habits/lifestyle changes, and family history are important factors.
General Signs/Symptoms: The assessment covers the nervous system, including disturbances in consciousness, memory loss, headaches, pain, dizziness, vertigo, and seizures. The musculoskeletal system assessment includes weakness, loss of coordination, tremors, numbness, and paralysis. Additional systems to consider include gastrointestinal and other systems (e.g., nausea/vomiting; bowel or bladder difficulties; swallowing difficulties; visual disturbance; speech difficulties).

Physical Examination

Neurological Examination: The examination comprises mental status, cranial nerves, motor system assessment (muscle strength, gait, stance, coordination, sensation), reflexes, and the autonomic nervous system.

Assessment Tools

Glasgow Coma Scale (GCS): Used to assess level of consciousness. It has three categories: Eye opening, Best motor response, and Best verbal response. The scores range from 3 to 15. A GCS between 3 and 8 indicates a severe head injury.

Diagnostic Testing

Positron Emission Tomography (PET) Scans: Assess blood flow, tissue composition, and brain function.
Cerebral Angiography: Uses contrast medium to visualize cerebral circulation and detect aneurysms or tumors, often accessing the femoral artery.
Lumbar Puncture (Spinal Tap): Involves inserting a needle into the subarachnoid space between the third and fifth lumbar vertebrae; useful for measuring cerebrospinal fluid (CSF) fluid or pressure or injecting a medication or contrast medium. Contraindicated with increased intracranial pressure.
Myelography: An X-ray of the spinal subarachnoid space after injecting a contrast agent; used to visualize the vertebral column and intervertebral disks.
Electroencephalogram (EEG): Measures electrical activity in the brain; used to diagnose and evaluate seizures, identify tumors or brain abscesses/infections, and confirm brain death.

Laboratory Testing

Cerebrospinal Fluid (CSF) Analyses: Analyzing CSF can reveal normal findings, such as a pH of 7.35-7.45, specific gravity of 1.007, and a clear, colorless, odorless appearance. Additionally, minimal WBCs and no RBCs along with positive protein and glucose are normal findings.

Nursing Management for Patients with Cervical Disc Prolapse

Immobilization: Immobilize/rest the cervical spine using methods like a cervical collar, cervical traction, and bed rest.
Muscle Spasm Control: Administer muscle relaxants to control muscle spasm.
Surgical Intervention: Prepare for surgical intervention if necessary, due to significant neurological deficit from nerve root compression.
Discharge planning: Teach patients to avoid extreme flexion, extension and rotation of the cervical spine during activity, keep the head in a neutral position while sleeping, avoid excessive automobile riding while experiencing acute phase symptoms.

Nursing Management for Patients with Lumbar Disc Prolapse

Bed Rest: Encourage the patient to remain on bed rest.
Drug Therapy: Administer appropriate analgesic and anti-inflammatory drugs.
Heat and Massage: Utilize heat and massage treatments by a physiotherapist to relax muscles.
Neurological Deficit Monitoring: Watch for any neurological deficits, such as muscle weakness, atrophy, loss of sensory/motor function, or unrelieved acute pain.
Gradual Activity Increase: Have the patient increase activity gradually.
Surgical Intervention: Prepare for surgical intervention (laminectomy) when indicated, to remove the ruptured disc.
Discharge Planning & Health Teaching: Encourage patient to do lumbar flexion exercises. Advise the patient to sleep on side with knees and hips flexed. Encourage proper posture. Consider a lumbar support (corset).

Management of Patients Following Laminectomy

Laminectomy: Removal of the lamina to expose the neural elements of the spinal canal. Allows for inspection, identification, and removal of pathology/compression from the spinal cord and roots.

Post-Operative Nursing Management for Cervical Disc

Vital signs and neuro checks: Monitor vital signs and neurological status frequently.
Sore throat management: Be aware of sore throats as a common complaint and avoid throat numbing sprays.
Pulmonary secretions: Observe for pulmonary secretions.

Nursing Process - Assessment (Pre-operative)

Past injury: Assess for past neck injury
Pain: Assess pain onset, location, radiation
Cervical spine area: Assess area around the cervical spine by palpation to assess muscle tone and tenderness
Range of motion: Assess range of motion in the neck and shoulders
Surgical info: Determine the patient's need for information about the planned operative procedure.

Post-Operative Assessment

Vital signs monitoring: Monitor blood pressure (BP) and pulse.
Bleeding evaluation: Evaluate any bleeding.
Drainage inspection: Inspect the dressing for serosanguineous drainage.
Headache assessment: Assess for headaches.
Extremity weakness evaluation: Check for weakness in upper and lower extremities.

Nursing Diagnoses

Pain: Pain related to surgical procedure.
- Interventions: Keep the patient flat in bed for 12-24 hours. Administer analgesics as needed. Consider a soft diet if dysphagia is present.
Impaired Physical Mobility: Impaired physical mobility related to post-operative surgical regimen.
- Interventions: Use of cervical collar. Teach patient to turn the body instead of the neck when looking from side to side. Encourage wearing shoes when ambulating.

Patient Teaching & Home Health Care

Cervical collar use: The cervical collar is usually worn for 6 weeks.
Neck movement restrictions: caution against extreme neck movements (flexing, extending, rotating) during activities/exercises. Avoid the prone position while sleeping.
Symptom monitoring: Encourage monitoring of signs and symptoms, such as fever and wound drainage.
Positioning and activity: Avoid prolonged sitting or standing periods (more than 30 minutes). Alternate tasks that don't involve body movement.

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Description

Test your knowledge on the assessment and management of neurological disorders. This quiz covers various aspects such as the Glasgow Coma Scale, health history assessment, and postoperative care. Determine how well you understand the key concepts in neurology.