Podcast
Questions and Answers
A client with a traumatic brain injury is at risk for increased intracranial pressure (ICP). Which nursing intervention is most important for controlling ICP?
A client with a traumatic brain injury is at risk for increased intracranial pressure (ICP). Which nursing intervention is most important for controlling ICP?
- Administering stool softeners to prevent straining
- Maintaining the head of the bed at 30-45 degrees (correct)
- Encouraging deep breathing and coughing exercises
- Clustering nursing activities to allow for extended rest periods
Which mechanism of injury is most likely in a patient who presents with diffuse axonal injury after a motor vehicle accident?
Which mechanism of injury is most likely in a patient who presents with diffuse axonal injury after a motor vehicle accident?
- Laceration
- Rotational forces (correct)
- Contusion
- Acceleration
A patient is diagnosed with diabetes insipidus following a traumatic brain injury. Which medication should the nurse anticipate administering?
A patient is diagnosed with diabetes insipidus following a traumatic brain injury. Which medication should the nurse anticipate administering?
- Dexamethasone
- Phenytoin
- Vasopressin (correct)
- Mannitol
Following a craniotomy, a client exhibits signs of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following nursing interventions is most appropriate for this client?
Following a craniotomy, a client exhibits signs of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following nursing interventions is most appropriate for this client?
A client with a brain tumor is prescribed dexamethasone. Which explanation should the nurse give regarding the primary purpose of this medication?
A client with a brain tumor is prescribed dexamethasone. Which explanation should the nurse give regarding the primary purpose of this medication?
The nurse is caring for a client who had intracranial surgery. Which assessment finding requires immediate intervention?
The nurse is caring for a client who had intracranial surgery. Which assessment finding requires immediate intervention?
A client reports pain, muscle spasm, and numbness in their left leg. Which diagnostic test would be most appropriate to assess for a herniated lumbar disc?
A client reports pain, muscle spasm, and numbness in their left leg. Which diagnostic test would be most appropriate to assess for a herniated lumbar disc?
Which post-operative teaching intervention is most important for clients following a laminectomy?
Which post-operative teaching intervention is most important for clients following a laminectomy?
A client has spinal stenosis. Which description best explains the pathophysiology of this condition?
A client has spinal stenosis. Which description best explains the pathophysiology of this condition?
A client with a spinal cord injury at the level of C4 is at risk for which complication?
A client with a spinal cord injury at the level of C4 is at risk for which complication?
Several hours after a spinal cord injury a client develops hypotension, bradycardia, and hypothermia. Which condition should the nurse suspect?
Several hours after a spinal cord injury a client develops hypotension, bradycardia, and hypothermia. Which condition should the nurse suspect?
A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. Which intervention is most important in preventing this complication?
A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. Which intervention is most important in preventing this complication?
Which nursing diagnosis is most important for a client with a C6 spinal cord injury?
Which nursing diagnosis is most important for a client with a C6 spinal cord injury?
What is the underlying cause of Parkinson's disease?
What is the underlying cause of Parkinson's disease?
A client with Parkinson's disease develops muscle rigidity. Which sign or symptom is associated with rigidity?
A client with Parkinson's disease develops muscle rigidity. Which sign or symptom is associated with rigidity?
The nurse notes that the client with Parkinson's disease has a mask-like expression, soft voice, and dysphagia. The nurse recognizes that these clinical manifestations are caused by what?
The nurse notes that the client with Parkinson's disease has a mask-like expression, soft voice, and dysphagia. The nurse recognizes that these clinical manifestations are caused by what?
A client with early Parkinson's disease asks about medications. Which class of medication is typically used early in the disease to maximize intrinsic dopamine?
A client with early Parkinson's disease asks about medications. Which class of medication is typically used early in the disease to maximize intrinsic dopamine?
The nurse is caring for an 87 year old gentleman admitted at 1100 with anorexia due to Parkinson's disease. He has a nasogastric tube and is alert and oriented x3. What is the priority nursing action?
The nurse is caring for an 87 year old gentleman admitted at 1100 with anorexia due to Parkinson's disease. He has a nasogastric tube and is alert and oriented x3. What is the priority nursing action?
Which sign or symptom is unique to Huntington's disease compared to Parkinson's disease?
Which sign or symptom is unique to Huntington's disease compared to Parkinson's disease?
A newly diagnosed client asks about the cause of Huntington's disease. Which statement by the nurse is most accurate?
A newly diagnosed client asks about the cause of Huntington's disease. Which statement by the nurse is most accurate?
What does the licensed vocational nurse do for the patient?
What does the licensed vocational nurse do for the patient?
A client is admitted to the emergency department after sustaining a traumatic brain injury (TBI) from a motor vehicle accident. Which initial assessment finding is most indicative of increased intracranial pressure (ICP)?
A client is admitted to the emergency department after sustaining a traumatic brain injury (TBI) from a motor vehicle accident. Which initial assessment finding is most indicative of increased intracranial pressure (ICP)?
A client with a traumatic brain injury (TBI) is receiving mannitol to reduce intracranial pressure (ICP). Which nursing intervention is most important to include in the plan of care?
A client with a traumatic brain injury (TBI) is receiving mannitol to reduce intracranial pressure (ICP). Which nursing intervention is most important to include in the plan of care?
A nurse is teaching a client and family about potential complications after traumatic brain injury (TBI). Which complication should the nurse emphasize as requiring immediate medical attention?
A nurse is teaching a client and family about potential complications after traumatic brain injury (TBI). Which complication should the nurse emphasize as requiring immediate medical attention?
A client with a traumatic brain injury (TBI) exhibits signs of acute confusion and agitation. Which nursing intervention is most appropriate to ensure the client's safety?
A client with a traumatic brain injury (TBI) exhibits signs of acute confusion and agitation. Which nursing intervention is most appropriate to ensure the client's safety?
A client with a brain tumor experiences a seizure. Which nursing intervention is most important to implement during the seizure?
A client with a brain tumor experiences a seizure. Which nursing intervention is most important to implement during the seizure?
A client is scheduled for a craniotomy for tumor removal. Which preoperative teaching should the nurse include to prepare the client?
A client is scheduled for a craniotomy for tumor removal. Which preoperative teaching should the nurse include to prepare the client?
A client is diagnosed with a herniated nucleus pulposus in the lumbar spine. Which activity should the nurse instruct the client to avoid?
A client is diagnosed with a herniated nucleus pulposus in the lumbar spine. Which activity should the nurse instruct the client to avoid?
The nurse is teaching log-rolling to a client before spinal surgery. Which statement describes why this technique should be used postoperatively?
The nurse is teaching log-rolling to a client before spinal surgery. Which statement describes why this technique should be used postoperatively?
A client with a T4 spinal cord injury is admitted to the emergency department. Which assessment finding requires the most immediate intervention?
A client with a T4 spinal cord injury is admitted to the emergency department. Which assessment finding requires the most immediate intervention?
A client with a spinal cord injury suddenly develops a severe headache, hypertension, and facial flushing. Which complication should the nurse suspect?
A client with a spinal cord injury suddenly develops a severe headache, hypertension, and facial flushing. Which complication should the nurse suspect?
A client with Parkinson's disease is prescribed carbidopa-levodopa. Which outcome indicates effective medication management?
A client with Parkinson's disease is prescribed carbidopa-levodopa. Which outcome indicates effective medication management?
A client with Parkinson's disease experiences frequent constipation. Which dietary modification should the nurse recommend?
A client with Parkinson's disease experiences frequent constipation. Which dietary modification should the nurse recommend?
Which of these clinical findings are associated with Huntington's disease?
Which of these clinical findings are associated with Huntington's disease?
A client with Huntington's disease is experiencing dysphagia. Which intervention should the nurse implement to promote safe swallowing?
A client with Huntington's disease is experiencing dysphagia. Which intervention should the nurse implement to promote safe swallowing?
A client admitted with a TBI is now exhibiting acute confusion 2 days after the injury. Which intervention should the nurse implement?
A client admitted with a TBI is now exhibiting acute confusion 2 days after the injury. Which intervention should the nurse implement?
Which of the following is useful in patients with Parkinson's disease?
Which of the following is useful in patients with Parkinson's disease?
A patient with a traumatic brain injury (TBI) is diagnosed with acute hydrocephalus. What is the primary underlying cause of this complication?
A patient with a traumatic brain injury (TBI) is diagnosed with acute hydrocephalus. What is the primary underlying cause of this complication?
A patient is diagnosed with a subdural hematoma following a fall. What is the most likely mechanism of injury leading to this type of hematoma?
A patient is diagnosed with a subdural hematoma following a fall. What is the most likely mechanism of injury leading to this type of hematoma?
After a motor vehicle accident, a patient is diagnosed with an acceleration-deceleration injury. Which of the following pathophysiological processes is most directly associated with this type of injury?
After a motor vehicle accident, a patient is diagnosed with an acceleration-deceleration injury. Which of the following pathophysiological processes is most directly associated with this type of injury?
Which of the following diagnostic findings is most indicative of a brain tumor affecting the frontal lobe?
Which of the following diagnostic findings is most indicative of a brain tumor affecting the frontal lobe?
A patient with a brain tumor is started on dexamethasone. What is the primary mechanism by which dexamethasone helps to alleviate symptoms associated with the tumor?
A patient with a brain tumor is started on dexamethasone. What is the primary mechanism by which dexamethasone helps to alleviate symptoms associated with the tumor?
A patient is scheduled for a craniotomy. What specific information should the nurse prioritize when teaching the patient about the procedure and postoperative care?
A patient is scheduled for a craniotomy. What specific information should the nurse prioritize when teaching the patient about the procedure and postoperative care?
Following a laminectomy, a patient reports new-onset urinary retention. What is the most appropriate initial nursing intervention?
Following a laminectomy, a patient reports new-onset urinary retention. What is the most appropriate initial nursing intervention?
A patient with spinal stenosis is experiencing chronic lower back pain. Which self-management strategy is most likely to provide long-term relief for this patient?
A patient with spinal stenosis is experiencing chronic lower back pain. Which self-management strategy is most likely to provide long-term relief for this patient?
A patient with a C6 spinal cord injury is being discharged. Which educational topic is most important for the nurse to emphasize to the patient and their family regarding skin care?
A patient with a C6 spinal cord injury is being discharged. Which educational topic is most important for the nurse to emphasize to the patient and their family regarding skin care?
A patient with a T6 spinal cord injury is at risk for autonomic dysreflexia. Which intervention is most crucial for the nurse to implement when this complication is suspected?
A patient with a T6 spinal cord injury is at risk for autonomic dysreflexia. Which intervention is most crucial for the nurse to implement when this complication is suspected?
A patient with cervical spinal cord injury is at risk for an ineffective breathing pattern. Which assessment parameter is most important for the nurse to monitor regularly in this patient?
A patient with cervical spinal cord injury is at risk for an ineffective breathing pattern. Which assessment parameter is most important for the nurse to monitor regularly in this patient?
In Parkinson's disease, degeneration of the substantia nigra leads to a deficiency of which neurotransmitter?
In Parkinson's disease, degeneration of the substantia nigra leads to a deficiency of which neurotransmitter?
A patient with Parkinson's disease is experiencing significant bradykinesia. Which nursing intervention is most likely to improve the patient's ability to perform activities of daily living (ADLs)?
A patient with Parkinson's disease is experiencing significant bradykinesia. Which nursing intervention is most likely to improve the patient's ability to perform activities of daily living (ADLs)?
A patient with Parkinson's disease is prescribed a monoamine oxidase B (MAO-B) inhibitor. What is the primary mechanism of action of this medication in managing Parkinson's symptoms?
A patient with Parkinson's disease is prescribed a monoamine oxidase B (MAO-B) inhibitor. What is the primary mechanism of action of this medication in managing Parkinson's symptoms?
Which assessment finding is most indicative of dysphagia in a patient with Parkinson's disease?
Which assessment finding is most indicative of dysphagia in a patient with Parkinson's disease?
What is the genetic inheritance pattern for Huntington's disease?
What is the genetic inheritance pattern for Huntington's disease?
A patient with Huntington's disease is exhibiting progressively worsening choreiform movements. Which nursing intervention is most important to implement to ensure the patient's safety?
A patient with Huntington's disease is exhibiting progressively worsening choreiform movements. Which nursing intervention is most important to implement to ensure the patient's safety?
A patient with Huntington's disease is demonstrating increasing cognitive decline and personality changes. Which diagnostic test is most likely to confirm the diagnosis and assess disease progression?
A patient with Huntington's disease is demonstrating increasing cognitive decline and personality changes. Which diagnostic test is most likely to confirm the diagnosis and assess disease progression?
Which of the following nursing interventions is most appropriate for a patient with Huntington's disease experiencing dysphagia?
Which of the following nursing interventions is most appropriate for a patient with Huntington's disease experiencing dysphagia?
What is the primary role of the licensed practical nurse (LPN) in the care of a patient with a traumatic brain injury?
What is the primary role of the licensed practical nurse (LPN) in the care of a patient with a traumatic brain injury?
A patient who sustained a traumatic brain injury is being cared for at home. The family reports that the patient is frequently confused and agitated, particularly in the evening. Which intervention should the nurse recommend to best manage the patient's symptoms?
A patient who sustained a traumatic brain injury is being cared for at home. The family reports that the patient is frequently confused and agitated, particularly in the evening. Which intervention should the nurse recommend to best manage the patient's symptoms?
A patient with a brain tumor is experiencing increased intracranial pressure (ICP). Which nursing intervention is most appropriate to include in the care plan to manage this issue?
A patient with a brain tumor is experiencing increased intracranial pressure (ICP). Which nursing intervention is most appropriate to include in the care plan to manage this issue?
A patient with a herniated lumbar disc is experiencing severe lower back pain. Which position should the nurse recommend to the patient to alleviate the pain?
A patient with a herniated lumbar disc is experiencing severe lower back pain. Which position should the nurse recommend to the patient to alleviate the pain?
Which statement best describes the purpose of teaching a patient log-rolling technique after spinal surgery?
Which statement best describes the purpose of teaching a patient log-rolling technique after spinal surgery?
A patient with a C4 spinal cord injury is at high risk for respiratory complications. What is the physiological basis for this risk?
A patient with a C4 spinal cord injury is at high risk for respiratory complications. What is the physiological basis for this risk?
What is the most appropriate action for the nurse to take first when a patient with a spinal cord injury develops signs and symptoms of autonomic dysreflexia?
What is the most appropriate action for the nurse to take first when a patient with a spinal cord injury develops signs and symptoms of autonomic dysreflexia?
A nurse is providing discharge instructions for a patient with Parkinson's disease who is prescribed carbidopa-levodopa. What information should the nurse emphasize regarding the administration of this medication?
A nurse is providing discharge instructions for a patient with Parkinson's disease who is prescribed carbidopa-levodopa. What information should the nurse emphasize regarding the administration of this medication?
Which dietary modification should the nurse recommend to a patient with Parkinson's disease who is experiencing constipation?
Which dietary modification should the nurse recommend to a patient with Parkinson's disease who is experiencing constipation?
A patient with Huntington's disease is experiencing choreiform movements. Which intervention should the nurse implement to minimize the impact of these movements?
A patient with Huntington's disease is experiencing choreiform movements. Which intervention should the nurse implement to minimize the impact of these movements?
Which sign or symptom most clearly differentiates Huntington's disease from Parkinson's disease?
Which sign or symptom most clearly differentiates Huntington's disease from Parkinson's disease?
The family of a patient newly diagnosed with Huntington's disease expresses concern about the genetic implications of the disease. What is the most appropriate nursing response?
The family of a patient newly diagnosed with Huntington's disease expresses concern about the genetic implications of the disease. What is the most appropriate nursing response?
A patient with a traumatic brain injury is started on mannitol. What specific parameter should the nurse monitor to assess the effectiveness of this medication?
A patient with a traumatic brain injury is started on mannitol. What specific parameter should the nurse monitor to assess the effectiveness of this medication?
Patients with Parkinson’s disease are at risk for developing autonomic nervous system dysfunction. Which of the following assessment findings would indicate the dysfunction of the autonomic nervous system?
Patients with Parkinson’s disease are at risk for developing autonomic nervous system dysfunction. Which of the following assessment findings would indicate the dysfunction of the autonomic nervous system?
A patient with Parkinson's disease displays a mask-like face with infrequent blinking. Which complication is the patient most at risk for?
A patient with Parkinson's disease displays a mask-like face with infrequent blinking. Which complication is the patient most at risk for?
What is the therapeutic goal for the medical management of Parkinson's disease?
What is the therapeutic goal for the medical management of Parkinson's disease?
A patient with a spinal cord injury at level T2 is being discharged. What is the most significant long-term complication the nurse needs to educate the patient about?
A patient with a spinal cord injury at level T2 is being discharged. What is the most significant long-term complication the nurse needs to educate the patient about?
Which of the following statements is true regarding spinal shock?
Which of the following statements is true regarding spinal shock?
Flashcards
Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI)
Damage to the brain from an external mechanical force, possibly leading to temporary or permanent impairment of cognitive, physical, and psychosocial functions.
Hemorrhage (TBI)
Hemorrhage (TBI)
Bleeding in the brain tissue, resulting from trauma.
Contusion (TBI)
Contusion (TBI)
Bruising of brain tissue, often associated with skull fractures.
Laceration (TBI)
Laceration (TBI)
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Cerebral Edema
Cerebral Edema
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Hyperemia
Hyperemia
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Hydrocephalus
Hydrocephalus
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Brain Herniation
Brain Herniation
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Open Head Injury
Open Head Injury
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Closed Head Injury
Closed Head Injury
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Acceleration Injury
Acceleration Injury
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Deceleration Injury
Deceleration Injury
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Concussion
Concussion
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Contusion
Contusion
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Hematoma
Hematoma
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Subdural Hematoma
Subdural Hematoma
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Epidural Hematoma
Epidural Hematoma
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Surgical Removal of Hematoma
Surgical Removal of Hematoma
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Control Increased ICP
Control Increased ICP
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Osmotic Diuretic - Mannitol
Osmotic Diuretic - Mannitol
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Therapeutic Coma
Therapeutic Coma
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Brain Herniation
Brain Herniation
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Diabetes Insipidus
Diabetes Insipidus
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Acute Hydrocephalus
Acute Hydrocephalus
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Labile Vital Signs
Labile Vital Signs
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Post-Traumatic Syndrome
Post-Traumatic Syndrome
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Cognitive and Personality Changes
Cognitive and Personality Changes
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Brain Tumor
Brain Tumor
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Neoplastic Growth
Neoplastic Growth
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Primary Brain Tumors
Primary Brain Tumors
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Metastatic Brain Tumors
Metastatic Brain Tumors
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Craniotomy
Craniotomy
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Craniectomy
Craniectomy
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Cranioplasty
Cranioplasty
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Herniation of Nucleus Pulposus
Herniation of Nucleus Pulposus
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Spinal Stenosis
Spinal Stenosis
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Anticonvulsants
Anticonvulsants
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Dopamine Agonists
Dopamine Agonists
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Destruction of Substantia Nigra
Destruction of Substantia Nigra
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Impairment of Semiautomatic Movements
Impairment of Semiautomatic Movements
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Muscular Rigidity
Muscular Rigidity
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Bradykinesia
Bradykinesia
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Pill-Rolling Tremor
Pill-Rolling Tremor
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Huntington's Disease
Huntington's Disease
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Choreiform Movements
Choreiform Movements
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Study Notes
Traumatic Brain Injury (TBI)
- Trauma, such as hemorrhage, contusion, and laceration, can cause cerebral edema, hyperemia, hydrocephalus, brain herniation, and/or death
- Etiology includes MVAs, falls, assaults, and sports-related injuries
Classification of Brain Injury
- Open head injury is a penetrating injury
- Closed head injury is a non-penetrating injury
Mechanisms of Injury
- Acceleration
- Deceleration
- Acceleration-Deceleration
- Rotational
Types of Injury
- Concussion
- Contusion
- Hematoma (subdural, epidural)
TBI Diagnosis
- CT
- MRI
- Neuropsychological Testing
TBI Therapeutic Interventions
- Surgical Removal of Hematoma
- Control Increased ICP via:
- ICP Monitoring
- Osmotic Diuretic - Mannitol* with urinary output monitoring
- Mechanical hyperventilation
- Therapeutic Coma
Complications of TBI
- Brain Herniation
- Diabetes Insipidus
- Acute Hydrocephalus
- Labile Vital Signs
- Post-traumatic Syndrome
- Cognitive and Personality Changes
TBI Nursing Diagnoses
- Ineffective Cerebral Tissue Perfusion
- Ineffective Airway Clearance
- Ineffective Breathing Pattern
- Acute Confusion
- Self-Care Deficit
- Acute/Chronic Pain
- Disturbed Sensory Perception
- Impaired Physical Mobility
- Risk for Injury
Brain Tumor Pathophysiology
- Neoplastic Growth of the Brain or Meninges
- Primary or Metastatic
- Compress or Infiltrate Brain Tissue
- Cause increased ICP
Brain Tumor Signs and Symptoms
- Seizures
- Motor and Sensory Deficits
- Headaches
- Speech and Vision Disturbances
- Personality Changes
- Hormone Disturbances
Brain Tumor Diagnosis
- MRI, Angiogram
- Magnetic Resonance angiogram (MRA)
- Hormone Levels
Brain Tumor Therapeutic Interventions
- Surgical Removal
- Radiation Therapy
- Chemotherapy
- Complimentary and alternative therapies
- Symptom Control
- Anticonvulsants
- Steroids (Dexamethasone) to reduce swelling
Brain Tumor Complications
- Seizures
- Headaches
- Memory Impairment
- Cognitive Changes
- Ataxia
- Hemiparesis
- Aphasia
- Lethargy
- Coma
- Death
Brain Tumor Nursing Diagnoses
- Risk for Acute or Chronic Confusion
- Self-Care Deficit (Dressing/Feeding/Toileting)
- Acute or Chronic Pain
- Risk for Injury Secondary to Disturbed Sensory Perception
- Impaired Physical Mobility
- Risk for Injury
Intracranial Surgery Indications
- Hematoma
- Tumor
- Arteriovenous (AV) Malformation
- Trauma
- Seizures
Types of Intracranial Surgery
- Craniotomy
- Craniectomy
- Cranioplasty
Intracranial Surgery: Preoperative Care
- Patient Education
- Anxiety Control
- Intensive care unit (ICU) Visit
Intracranial Surgery: Postoperative Care Nursing Diagnoses
- Risk for Ineffective Cerebral Tissue Perfusion
- Risk for Infection
- Disturbed Body Image
- Deficient Knowledge
Herniated Disk Pathophysiology
- Herniation of Nucleus Pulposus
- Compression of Nerve Root(s)
- Most Common in Cervical and Lumbar regions
- Etiology includes injury or may be unknown
Herniated Disk Signs and Symptoms
- Pain
- Muscle Spasm
- Numbness or Tingling of Extremity
- Weakness
- Atrophy
Herniated Disk Diagnostic Tests
- MRI
- Myelogram
Herniated Disk Therapeutic Interventions
- Rest
- Physical Therapy
- Traction
- Muscle Relaxants
- NSAIDs, Analgesics
- Epidural Anesthetic/Steroid
- Surgery
Herniated Disk Surgery: Types
- Laminectomy
- Diskectomy
- Spinal Fusion
- Artificial Disk
Herniated Disk Surgery: Complications
- Hemorrhage
- Nerve Root Damage
- Reherniation
- Herniation of Another Disk
Herniated Disk: Preoperative Care
- Routine Teaching
- Teach Log-rolling Technique
Herniated Disk: Postoperative Care Nursing Diagnoses
- Acute Pain
- Impaired Urinary Elimination
- Impaired Physical Mobility
Spinal Stenosis
- Spinal canal compresses the spinal cord
- Arthritis is a major cause
- Laminectomy is a common treatment
Spinal Cord Injury Pathophysiology
- Damage to Nerve Fibers
- Interference with Communication Between Brain and Body
Spinal Cord Injury: Causes
- MVAs
- Falls
- Sports Injuries
- Assault
Spinal Cord Injury: Signs and Symptoms
-
Cervical Injury
- Paralysis
- Paresthesias
- Impaired Respiration
- Loss of Bladder and Bowel Control
- Quadriplegia/paresis
- C3 or Above Fatal
-
Thoracic/Lumbar Injury
- Paraplegia/paresis
- Altered Bowel and Bladder Control
Spinal Shock
- Sympathetic Nervous System (SNS) Disruption
- Vasodilation
- Hypotension
- Bradycardia
- Hypothermia
- Urine and Feces Retention
Spinal Cord Injury: Complications
- Infection
- DVT
- Orthostatic Hypotension
- Skin Breakdown
- Renal Complications
- Depression and Substance Abuse
- Autonomic Dysreflexia (involves thoracic nerves of the spine or above T6 or above)
Spinal Cord Injury: Therapeutic Measures
- Cared for in ER
- Immobilization until assessed
Spinal Cord Injury: Diagnostic tests
- X-Ray
- CT Scan
- MRI
Spinal Cord Injury: Emergency Management
- Respiratory
- Gastrointestinal
- Genitourinary
- Immobilization
Spinal Cord Injury: Surgical Management
- Stabilize Spine with:
- Halo Brace
- Rods
- Corset
- Brace
- Body Cast
Spinal Cord Injury: Skeletal Traction
- Crutchfield tongs
- Gardner-Wells tongs
Spinal Cord Injury: Nursing Diagnoses
- Impaired Gas Exchange
- Ineffective Airway Clearance
- Risk for Autonomic Dysreflexia
- Reflex Urinary Incontinence
- Constipation
- Impaired Physical Mobility
- Self-Care Deficit (Dressing/Feeding/Bathing)
- Risk for Impaired Skin Integrity
- Ineffective Role Performance
- Risk for Sexual Dysfunction
- Anxiety
Parkinson’s Disease
- Destruction of Substantia Nigra
- Decreased Dopamine Production
- Relative Excess of Acetylcholine
- Impairment of Semiautomatic Movements
- Etiology is often Unknown but can be Genetic, related to Certain Drugs or Encephalitis
Parkinson’s Disease: Signs and Symptoms
- Muscular Rigidity
- Bradykinesia
- Changes in Posture
- Pill-Rolling Tremor
- Difficulty Initiating Movement
- Shuffling and Freezing Gait
Autonomic Nervous System
- (ANS) Dysfunction Symptoms
- Diaphoresis
- Constipation
- Orthostatic Hypotension
- Drooling
- Dysphagia
- Seborrhea
- Frequent Urination
Parkinson’s Disease Diagnostic Tests
- History
- Physical Examination
- MRI
Parkinson’s Disease Therapeutic Interventions
- Dopamine Agonists
- Monoamine Oxidase B Inhibitors
- Catechol-O-methyltransferase (COMT) Inhibitors
- Pallidotomy
- Deep Brain Stimulation
Dopamine Drugs Used for Parkinsonism
- Amantadine
- Apomorphine
- Bromocriptine (Parlodel)
- *Carbidopa-levodopa (Sinemet)
- Entacapone (Comtan)
- Levodopa (Larodopa)
- Pramipexole (Mirapex)
- Ropinirole (Requip)
- Selegiline (L-Deprenyl, Eldepryl)
- Tolcapone (Tasmar)
Parkinson’s Disease: Medical Management
- Goal involves controlling symptoms with physical therapy and drug therapy
- Beneficial PT programs include massage, heat, exercise, and gait training
- Speech therapy addresses swallowing and speech issues
- Early in the course maximize intrinsic dopamine with dopamine receptor agonists Pramipexole (Mirapex) or Ropinirole (Requip)
Parkinson’s Disease Nursing Diagnoses
- Impaired Physical Mobility
- Self-Care Deficit (Dressing/Feeding/Toileting/Bathing)
- Risk for Injury
- Also Diagnoses for Dementia
Parkinson’s Syndrome: Nursing Care
- Primary focus: maintain mobility and prevent injury
- Assessment focuses on weakness, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements
- Be alert for lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination
- As disease progresses: immobility ensues
Huntington’s Disease
- Pathophysiology/Etiology
- Genetic: Autosomal Dominant
- Degeneration of Parts of Brain
Huntington’s Disease Signs and Symptoms
- Dementia: Personality Changes, Inappropriate Behavior, Paranoia, Violence
- Choreiform Movements
- Dysphagia
- Depression
- Death
Huntington’s Disease Diagnosis
- Family History
- MRI
- CT scan
- Genetic Testing/Counseling
Huntington’s Disease Therapeutic Interventions
- Antipsychotics
- Antidepressants
- Antichorea Agents
- Stem Cell Transplants: Experimental
Huntington’s Disease Nursing Care
- Cared for on an outpatient basis
- Focus on Swallowing difficulty
- Encourage patient to discuss End-of-life care
Comparison of Parkinson’s Disease and Huntington’s Disease
| Symptoms | Parkinson’s Disease | Huntington’s Disease |
|---|---|---|
| Tremors | Present | Absent |
| Bradykinesia/akinesia | Present | Absent |
| Muscle rigidity | Present | Absent |
| Memory dysfunction | Late | Late |
| Cognitive dysfunction | Late | Present |
| Inability to perform ADLs | Progressive | Progressive |
| Involuntary movements | Absent | Present |
| Depression | Present | Present |
LPN/LVN Role
- Promote positive self-esteem of client
- Promote a therapeutic environment
- Assist in the care of the cognitively impaired client
- Provide care to immobilized client based on need
- Evaluate client oxygen saturation
- Participate in staff education (e.g., in-services, continued competency)
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