Nurs222 Exam 3 Study Guide PDF

Ch 36: CNS Problems Quizlet Alzheimer’s Disease Pathophysiology Review Most common type of dementia Structural changes ○ Neurofibrillary tangles: twisted fibrous tissues w/ abnormal tau protein Impair impulse ability b/t...

Ch 36: CNS Problems Quizlet Alzheimer’s Disease Pathophysiology Review Most common type of dementia Structural changes ○ Neurofibrillary tangles: twisted fibrous tissues w/ abnormal tau protein Impair impulse ability b/t neurons ○ Neuritic plaques: degenerating nerve terminals w/ abnormal beta amyloid Impair neuronal transmission Neurotransmitter abnormalities ○ Ach, dopamine, norepinephrine, serotonin Impaired cognition, recent memory, & ability to acquire new memory Etiology & Genetic Risk Exact cause unknown Risk factors ○ Age: > 65 ○ Gender: women are more likely ○ Genetic: apolipoprotein E (APOE) Not definitive for development ○ Others: CVD, smoking, TBI, environmental agents, immunologic changes, stress, sleep deprivation, down syndrome Health Promotion/Disease Prevention No way to prevent Chronic conditions may contribute (DM, strokes, etc) ○ Diet, exercise, smoking & drinking cessation can help prevent Recognize Cues: Assessment Hx - get info from family members Onset, duration, progression, + course of sx !! Functional status (ADLs) Personality changes Physical Assessment Stages (3) - not orderly ○ Early (mild): independent w/ memory lapse Deny sx, forget names, misplace items, hard to recall info ○ Moderate: longest stage w/ lot of changes to all cognitive functions  Agitated, trouble w/ finances, disorientated, speech difficulty, incontinence, compulsive behavior, agnosia ○ Late (severe): completely dependent & bedridden Loss of mobility & verbal skills Cognition changes ○ Hippocampal, frontal, or parietal dysfunction New memory and information retrieval deficits ○ Temporal & parietal dysfunction Apraxia (can’t form words), aphasia (can’t speak or understand), anomia (can’t find words), agnosia (sensory comprehension loss) ○ Frontal lobe impairment Judgment, decision-making, attention span, & concentration affected ○ Tests MMSE, MoCA, clock drawing test Behavior & Personality changes ○ Aggressive, mood swings, sundowning, hide/wander, paranoia Self-management changes ○ Personal appearance doesn’t matter, incontinence, less mobile, decreased appetite Psychosocial Assessment Lab & Imaging PET: to detect amyloid MRI/CT: look at brain structure Genetic testing: APOE-e4 Generate Solutions & Take Actions Managing memory & cognitive dysfunction ○ Nonpharmacologic Structured & consistent environment (calm, noise low) Manage comorbidities Cognitive stimulation & memory training Reminisce therapy Orientation & validation Promote self-management ○ Pharmacologic Psychotropics Cholinesterase inhibitors Donepezil, galantamine, rivastigmine Monitor HR, dizziness, falls N-methyl-D-aspartate Memantine  Amyloid Aducanumab Antidepressants Preventing injuries or falls ○ Frequent chks ○ Take on walks ○ Structured activities to keep busy ○ Remove dangerous items ○ Seizure actions ○ Talk calmly & softly Preventing elder abuse ○ Provide education to family about promoting their health ○ Take it one day at a time, use humor, seek respite care periodically, relaxation techniques Managing sx at EOL ○ Hospice/palliative care ○ Coordinate w/ RT for dyspnea ○ Feeding tube near end Care Coordination & Transition Management Home care management ○ Respite care to give the family a break Self-management education ○ Develop plan w/ family to make reasonable & realistic Healthcare resources ○ Alzheimer’s association Parkinson's Pathophysiology Review Progressive neurodegenerative disease Decreased dopamine b/c of the degeneration of the substantia nigra leads to increased Ach causing involuntary movement Begins as unilateral then progresses to complete dependency 4 cardinal signs ○ TRAP Tremor, rigidity (muscle), akinesia or bradykinesia, postural instability Signs before the cardinal sx ○ Constipation, soft voice, micrographia, loss of smell, sexual dysfucntion, sleep disturbances Etiology & Genetic Risk  Exact cause unknown Environmental factors ○ Pesticides, herbicides, chemicals, & metals > 40 y/o Familial tendency ○ Mitochondrial DNA variations that destroy dopamine producing neurons TBI Recognize Cues: Assessment Hx Inquire about when sx started Physical Assessment Resting tremors in extremities Rigidity assessment Facial expression (masklike) Emotional, speech, & bladder/bowel changes Lab & Imaging Dx based on clinical findings No specific tests CSF, SPECT, DaT Generate Solutions & Take Actions Promoting mobility ○ Nonsurgical Drugs - dopamine agonists (apomorphine, pramipexol, ropinirole), levodopa/carbidopa, MAOI-Bs, COMT inhibitors, amantadine, rivastigmine medical marijuana Dietitian, exercise programs, monitor sleep patterns, speech therapist ○ Surgical Deep brain stimulation Stereotactic pallidotomy Managing cognitive dysfunction ○ Drugs - pimavanserin, venlafaxine ○ Emphasize strength & positively reinforce Care Coordination & Transition Management Home care prep ○ Case manager or healthcare professional for holistic approach Self management education ○ Following drug therapy instructions & report AE ○ Mainting or improving QOL Healthcare resources  ○ National Parkinson Foundation Migraines: recurrent episodic attacks of head pain often w/ nausea, photosensitivty, sensitivity to sound or head movements Thought to be caused by activation of the trigeminovascular system (TVS) which leads to vasodialtion, tissue swelling, & throbbing pain Triggers ○ Caffeine, red wine, MSG, intense light, stress, excessive fatigue, change in weather, products w/ tyramine, preservatives, artificial sweeteners Aura: sx of CNS that signals onset Chronic: occur 15 days a month Episodic: < 15 days Dx ○ Based on physical, neurologic, & psychological assessment ○ MRI Management ○ Abortive drug therapy to alleviate pain during aura phase ○ NSAIDs for mild cases ○ Caffeine to narrow vessels ○ Antiemetics ○ Triptans, ditans, ergotamine for severe ○ Medical marijuana ○ Integrative therapies - yoga, massage, etc Seizures & Epilepsy: a seizure is an abnormal, sudden, uncontrolled electrical discharge of neurons w/in the brain & epilepsy is a chronic disorder of repeated unprovoked seizure activity Postictal state: after the seizure state Types of Seizures Generalized: involve both cerebral hemispheres ○ Tonic-clonic: last 2 to 5 mins Start with tonic phase - stiffening or rigidity of muscle & loss of consciousness Then clonic phase - rhythmic jerking of all extremities ○ Myocolnic: brief jerking or stiffeninf of extremities May occur singularity or in groups & symmetric or asymmetric ○ Atonic: sudden loss of muscle tone where the pt falls Followed by confusion Drug therapy resistant with these seizures Partial (focal or local): involves one hemisphere ○ Complex partial: pt is unaware & may wander, potentially blackout  ○ Simple partial: remain conscious & often have an aura Etiology and Genetic Risk Primary: idiopathic associated with genetics Secondary ○ Underlying brain lesion (tumor or trauma) ○ Metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, high fever, stroke, head injury, substance abuse, heart disease Recognize Cues: Assessment & Take Action Assessment How many seizures, how long they last, pattern Aura or not Taking prescribed meds or herbs Has had head trauma, high fever, stroke, HTN Dx tests Based on hx & physical EEG, CT, MRI, PET scan Take Action Nonsurgical ○ Drug therapy Phenytoin & fosphenytoin: h/a, drowsiness, perform frequent oral care, should not be on warfarin, Carbamazepine: dizzy, drowsy, monitor for rash, also used for chronic neuropathic pain Ethosuximide: dizzy, drowsy, impaired cognition, ataxia, gingival hyperplasia Surgical ○ Vagal nerve stimulation for simple or complex partial seizures Similar to a pacemaker Pt can stimulate it when they feel an aura Observe for complications Hoarseness, cough, dyspnea, neck pain, dysphagia Avoid MRIs, microwaves, shortwave radios Care Coordination & Transition Management AEDs must NOT be stopped even if the seizures have stopped ○ Refer pt to social service or case manager if pt can not afford these meds Balanced diet, rest, & stress reduction Keep a seizure diary Meningitis: an infection of the meninges of the brain and spinal cord (specifically the pia & arachnoid mater)  Organisms enter via the bloodstream or direct into CNS ○ Direct entry: trauma, surgery, ruptured brain abscess, basilar skull fx, Infections linked to meningitis ○ Otitis media, acute or chronic sinusitis, tooth abscess, tongue piercing (rare) Results of meningitis ○ Increased ICP, change in cereal bloodlfow, thrombus formation Types Viral (most common) Organisms causing ○ Enterovirus, HSV-2, varicella zoster, mumps, HIV Sx ○ Alter cellular metabolism, genital infections, alter production of enzymes or neurotransmitters Bacterial Organisms causing ○ Meningococcal meningitis (medical emergency & highly contagious), Streptococcus pneumoniae, Neisseria meningitidis Recognize Cues: Assessment & Take Action Complete neurological & neurovascular assessment ○ Nuchal rigidity ○ Decreased LOC ○ Disorientation ○ Photophobia & nystagmus (involuntary eye movement) ○ Hemiparesis, cranial nerve dysfunction ○ h/a, muscle aches/pain, n/v, fever, chills, tachycardia, red macular rash Dx tools ○ CSF analysis ○ Increased ICP ○ CIE, CBC, Xray, CT, MRI Interventions ○ Vax prevention ○ Accurate monitoring & documenting of neurologic status ○ Cranial nerve testing ○ Broad spectrum antibiotic ○ DROPLET precautions ○ Drugs Mannitol: for increased ICP Rifampin, ciprofloxacin, ceftriaxone: prophylaxis for close contact ○ Vascular assessment  Questions 1. The nurse is providing health teaching about risk factors for Alzheimer’s disease. Which risk factor would the nurse include in the teaching? ○ Spinal cord injury ○ Atrial fibrillation ○ Peptic ulcer disease ○ Traumatic brain injury 2. The nurse is caring for a client with early-stage Alzheimer disease (AD). Which nursing action is most appropriate when caring for this client? ○ Use validation therapy. ○ Provide a structured environment. ○ Give a cholinesterase inhibitor. ○ Refer the client to the social worker. 3. The nurse is teaching a client, newly diagnosed with migraines, about trigger control. Which statement made by the client demonstrates understanding of the teaching? ○ “I can still eat Chinese food.” ○ “It is okay to drink a few wine coolers.” ○ “I should not miss any meals.” ○ “I need to use artificial sweeteners in my coffee.” 4. A client with Parkinson’s disease reports having auditory hallucinations. What drug would the nurse anticipate may be prescribed for the client? ○ Phenytoin ○ Levodopa ○ Ubrogepant ○ Pimavanserin 5. The nurse is teaching a family caregiver how to promote communication with a client who has Alzheimer’s disease. Which statement by the caregiver indicates a need for further teaching? ○ “I will ask simple, direct questions that require a “yes” or “no” answer.” ○ “I will use hand and facial gestures to help with understanding what is said.” ○ “I will assume that the client cannot understand any communication.” ○ “I will limit choices for the client to prevent frustration.” 6. The nurse is planning health teaching for a client who has Parkinson’s disease and family about rasagiline. Which instruction is a priority before the client begins this drug? ○ “Avoid foods, drinks, and drugs that contain tyramine, such as cheese.” ○ “Be aware that the client may experience cognitive impairment.” ○ “Long-term use of this drug may cause psychotic behaviors.” ○ “Your provider may also prescribe levodopa for you.” 7. A client with newly diagnosed migraines is being discharged with a prescription for sumatriptan. Which statement by the client indicates an understanding of the nurse’s discharge instructions? ○ “Birth control is not needed while taking sumatriptan.” ○ “I will report any chest pain right away.” ○ “St. John’s wort can also be taken to help my symptoms.” ○ “Sumatriptan can be taken as a last resort.” 8. The nurse is admitting a client with a history of seizures when the client suddenly begins to seize. What would the nurse do next? ○ Document the length and time of the seizure. ○ Place a tongue blade in the mouth. ○ Position the client on the side. ○ Restrain the client. 9. A client is admitted with bacterial meningitis. Which nursing intervention is the priority for this client? ○ Assess neurologic status at least every 2 to 4 hours. ○ Decrease environmental stimuli. ○ Manage pain through drug and nondrug methods. ○ Monitor hourly intake and output. 10. A client receiving propranolol as preventive therapy for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse? ○ Dry mouth ○ Slow heart rate ○ Tingling feelings ○ Warm sensation 11. The nurse is caring for a client diagnosed with vascular dementia. The nurse recognizes that which health problem is associated with this type of dementia? ○ Epilepsy ○ Meningitis ○ Stroke ○ Migraines 12. A client has been admitted with new-onset status epilepticus. Which seizure precaution(s) would the nurse implement? (Select all that apply.) ○ Padded tongue blade at the bedside ○ Intravenous (IV) access ○ Moderate sedation ○ Suction equipment at the bedside ○ Side rails raised 13. The nurse is caring for a client who is diagnosed with middle stage (moderate) Alzheimer’s disease. What assessment finding(s) would the nurse expect? (Select all that apply.) ○ Wandering ○ Mild impaired cognition ○ Sleeping problems ○ Psychoses ○ Seizures ○ Agnosia 14. The nurse is teaching a family caregiver about the need for self-care. Which health teaching statement(s) would the nurse include? (Select all that apply.) ○ “Take each day one at a time.” ○ “Try to find the positive aspects of each incident or situation.” ○ “Use humor with the person for whom you are caring.” ○ “Set aside time each day for rest or recreation away from the client, if possible.” ○ “Seek respite care periodically for longer periods of time.” ○ “Use relaxation techniques, including meditation and massage.” The nurse assesses a client with a diagnosis of Alzheimer’s disease (AD). Which of the following assessment findings would demonstrate the client has progressed to the moderate stage? Select all that apply. Unable to dress Forgets neighbors names Is unable to balance the checkbook Demonstrates agnosia Gets lost when traveling to familiar places Cannot identify time place and event Unable to find the new grocery store A client with moderate-stage Alzheimer’s disease (AD) in a memory care unit appears to be frightened at the assigned dining room table. What would be the nurse’s most appropriate action?  Explain to the client there is no cause for alarm Move the client to another table Encourage active conversation at the table Assess surroundings for sensory stimuli The nurse is preparing to teach a client who has been prescribed ropinirole for Parkinson’s disease. Which of the following statements would the nurse include when teaching the client and family? Select all that apply. Move slowly when changing position from sitting to standing Chane the patch every 24 hours to a new site on your arm This drug causes sleepiness so do not drive or operate machinery while taking Be sure to report if this drug causes worse trouble with motor movements Do not eat cheese, wine, or cured or smoked foods while taking ropinirole Have someone take your BP every day The nurse is preparing a teaching plan for a client with migraine headaches. The client has been prescribed propranolol for prevention and sumatriptan for acute episodes. Which of the following statements would the nurse include in teaching this client? Select all that apply. Take your pulse everyday at around the same time Report a pulse greater than 100 beats/min to your provider Take vitamin D supplements daily Change positions slowly when you first start propranolol Take the sumatriptan as soon as symptoms begin Report any episodes of chest pain to your provider The nurse is planning health teaching for a client who has late-stage Alzheimer’s disease (AD). Which of the following statements would be most appropriate for the nurse to include for the client and family? A. “The client should have input into advance care planning with the health care team.” B. “The client may need placement in a memory care unit in the local assisted-living facility.”  C. “The client likely needs palliative care to manage pain and other symptoms to promote comfort.” D. “The client would be an ideal candidate to attend adult day care while you are working during the day.” The nurse is assessing an ambulatory client who was recently diagnosed with early Parkinson’s disease. Which of the following client findings would the nurse anticipate during the assessment? A. Lewy body dementia B. Resting tremors of the arms C. Inability to chew or swallow food D. Urinary incontinence A hospitalized client experiences a tonic-clonic seizure that is observed by the nurse. Which of the following actions by the nurse would be most appropriate during the seizure? Select all that apply A. Lower the client gently to the floor. B. Insert an oropharyngeal airway. C. Gently suction any excess oral secretions if possible. D. Take the client’s vital signs. E. Move any objects that might harm the patient. F. Administer diazepam or lorazepam immediately