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71 Cards in this Set
- Front
- Back
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Parietal lobe |
Analyze sensory information Awareness of body in space Size and shape discrimination |
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Occipital lobe |
Visual interpretation Memory |
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Temporal lobe |
Memory of sound Understanding of language & music |
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Frontal lobe |
Concentration Memory Motor function Broca's Area Affect Personality Judgement Inhibitions |
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Seizures |
Single event, of abnormal uncontrolled electrical discharge in the brain that disrupts a person's normal brain ability |
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Epilepsy |
A chronic medical condition where there are many, unplanned, frequent, seizures |
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During the neurological assessment, the patient cooperates with the nurse's directions to grip with the hands and to move the feet but is unable to respond orally to the nurse's question. The nurse will suspect:
A) A brainstem lesion B) Damage to the frontal lobe C) A temporal lesion D) Damage to the parietal lobe |
Answer: B |
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Causes of seizures in people under 20 years old |
Brain damage from birth Congenital defects of CNS Infection Trauma Genetic influences |
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Causes of seizures in people between 20 and 30 years old |
Trauma Vascular disease Brain tumors |
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Causes of seizures in people greater than 50 years old |
CVA Brain tumor |
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Seizure phases |
Prodromal Phase Aural Phase Ictal Phase Postictal Phase
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Prodromal Phase of a Seizure |
Signs or activity which come before the seizure Example: many have a "bad" feeling; a headache
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Aural Phase of a Seizure |
Sensory activity which precede a seizure Example: smelling a burning smell; seeing halos |
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Ictal Phase of a Seizure |
Full seizure; the patient is having the seizure NOW |
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Postictal Phase of a Seizure |
Time of recovery after the seizure |
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Generalized Seizure |
Every lobe in the brain is being shocked at one time Can break down into probable altered consciousness and brief/possible altered consciousness Includes generalized tonic-clonic seizures, absence seizures, myoclonic seizures, tonic seizures, clonic seizures, and atonic seizures |
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Partial Seizure |
Localized at the beginning; starts in one area Breaks down to Alert consciousness and altered consciousness Includes simple partial seizures and complex partial seizures Can develop into generalized seizures if not treated Usually see the effects in the opposite side of the body |
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Probable altered consciousness in generalized seizures |
Significant change of consciousness Includes generalized tonic-clonic seizures and absence seizures Worst types of seizures |
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Generalized Tonic-Clonic Seizures |
Symptoms: loss of consciousness , falling to ground, incontinent, cyanosis, excessive salivation, bite tongue/cheek, Tightening and shaking Postictal: sore muscles, fatigue, need sleep, pt can't recall seizure Also know as Grand Mal seizures A generalized probable altered consciousness seizures The typical seizure you think of DO NOT STICK ANYTHING IN MOUTH and Put them on their side |
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Absence Seizures |
May see the patient drift away with fluttering of the eyes Also known as Petty Mal seizures A type of generalized probable altered consciousness seizure Typically kids; usually stops by adolescence or changes to different type of seizure Occur up to 100 times a day May have a prodromal by hyperventilation & flashing lights May see confusion/bizarre behavior and can affect kid's academic performance |
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Atonic Seizures |
Muscles go flaccid Type of brief/possible altered consciousness generalized seizures |
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Myoclonic Seizures |
Quick tremor or jerk Type of generalized brief/possible altered consciousness generalized seizures |
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Tonic Seizures |
Tightening A generalized brief/possible altered consciousness seizure |
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Clonic Seizures |
Shaking A generalized brief/possible altered consciousness seizure |
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Simple Partial Seizures |
No loss of consciousness Less than one minute May involve simple motor, sensory (or combination) |
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Complex Partial Seizures |
Alteration in consciousness or a clouding of consciousness Greater than one minute Confused postictally Complex symptoms Can involve behavioral, emotional, affective & cognitive functions |
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Complications of Seizures |
Status Epilepticus Psychosocial |
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Status epilepticus |
Neuro emergency It's when the seizure does not break Seizure activity continues after 5 minutes Give Valium or Adivan (slows activity), phenobarbital (helps break activity) IV |
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Seizure Dx |
Accurate dx is critical Accurate health hx & comprehensive description of seizure EEG MRI or CT |
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Tx of Seizures |
Dilantin, Tegretol, Depakote, Keppra, Klonopin, Neurontin, Lamictal Monitor serum blood levels with Dilantin Surgery (Vagal Nerve Stimulator; surgically remove brain tissue) Dilantin is drug of choice; therapeutic range is 10-20mcg |
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Nursing Care Post Seizure |
Ensure physical safety MAINTAIN AIRWAY Assist in ventilation if pt respiratory arrests NEVER PLACE ANYTHING IN MOUTH Suction PRN Establish IV Administer phenobarbital, dilantin, benzodiazepines |
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Multiple Sclerosis (Definition) |
Chronic progressive degenerative disorder of the CNS characterized by disseminated demyelination of the nerve fibers of the brain and spinal cord |
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The nurse is called to the patient's room when the patient experiences a seizure. Upon finding the patient in a clonic reaction, the nurse should:
A) Turn the patient onto his side B) Start oxygen by mask at 6L/min C)Restrain the patient's arm and legs D) Place tongue blade in the patient's mouth |
ANSWER: A |
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Multiple Sclerosis (Onset, etiology, characteristics) |
Onset: 20-50 y/o; women > men; mainly caucasian Etiology: Unclear Characteristics: Activated T cells disrupt blood brain barrier -->inflammatory response-->demyelination; Plaques form (sclerosis) on axon making it harder for nerve impulses to pass; eventually axons degenerate and no impulse can pass (late in disease) Temporary myelin regeneration = remission
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Clinical Course of MS |
Relapsing Remitting Primary Progressive Secondary Progressive Progressive Relapsing
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Relapsing Remitting course of MS |
85% of patients fall into ths Remission for extended periods of time with flare-ups 25+ years prognosis before things debilitate them Clear pattern of remission and of relapses |
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Primary Progressive course of MS |
Progressive disease that may have plateaus but only temporary improvements 10% of patients No remission Prognosis is poor |
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Secondary Progressive course of MS |
Begins like relapsing-remitting and then deteriorates |
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Progressive Relapsing course of MS |
From onset, disease progression of disability with clear acute relapses after each remission with or without recovery |
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Signs and Symptoms of MS |
Motor: weakness to paralysis; muscle spasticity Sensory: numbness/tingling; partial blindness; decreased hearing; blurred vision; neuropathic pain Cerebellar: nystagmus; dysphagia; ataxia Others: fatigue; bowel and bladder changes; sexual disturbances ****S/s decrease during pregnancy but during postpartum women are at greater risk for disease exacerbation |
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Dx and Tx of MS |
Dx: H&P, clinical manifestation, CSF analysis = increased immunoglobulin G; delayed evoked potential response; CT & MRI show sclerotic plaques Tx: NO CURE; prednisone & ACTH to decrease inflammation; immunomodulator drugs (Betaseron); receptor modulators; muscle relaxants; surgery; avoid triggers
**triggers include heat, cold, stress and infections **patients need to avoid crowds during flu season |
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MS Nursing Care |
Promote optimal independence and functioning Manage symptoms Optimal nutrition Prevent complications of limited mobility Exercise helps (especially water sports) but NOT DURING AN ACUTE EXACERBATION |
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A 28 y/o woman who has MS asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate?
B) "Women with MS frequently have premature labor." C) "Symptoms of MS are likely to become worse during pregnancy." D) "MS is associated with a slightly increased risk for congenital defects." |
Answer: A |
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Parkinson's Disease Triad |
Bradykinesia Tremor Rigidity |
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Parkinson's Disease (Characterization and Cause) |
Characterization: slowing down of the initiation and execution of movement (bradykinesia); muscle rigidity; tremor at rest; gait disturbance Cause: decrease in Dopamine producing neurons
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Parkinson's Disease (Clinical manifestations) |
Clinical Manifestations: Early--slight limp, slight tremor, dec. in arm swing Late--tremor (pill roling, aggravated by stress and inc concentration, worse at rest); rigidity (resistance to passive movement through ROM, caused by sustained muscle contraction); bradykinesia (stooped shoulders, masked expression, little if any swing in arms, shuffling gait, drooling, slurred speech) |
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Treatment for PD |
Medications: Dopamine Precursors (sinemet), Dopamine Receptor agonists (dec. amount of dopamine needed at the site), dopamine agonists (helps store it better) Surgery: Deep brain stimulator implantation (current to brain, can change setting d/t symptoms and is reversible) |
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Nursing Care of PD |
Promote optimal motor function: exercise Promote self care Promote optimal speech Bowel regiment to prevent constipation Nutriton (Aspiration risk, maintain body weight, eat with supervision/suction available, HOB eleveated, sitting upright) Falls risk Drooling (atropine 1% solution) Speech therapy, physical therapy Adequate fluids |
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Which of the following question should the home health nurse ask to determine if the meds are being given in appropriate dosages and times?
A) Is your weight remaining the same? B) Do you experience any night sweats? C)Can you see the television from a comfortable distance? |
Answer: D |
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Myasthenia gravis (Definition) |
An autoimmune disease Neuromuscular junction disease that causes varying degrees of weakness of particular skeletal muscles Secondary to autoimmune process that decrease the number of ACh receptors Typically thought to be started by a viral infection
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Clinical Manifestations of MG |
Easy muscle fatigue; restored after rest Muscles affected--eyes, eyelids, chewing, swallowing, speaking and breathing Typically, muscle weakness is worse by the end of the day Major complications: Aspiration (#1 CONCERN), respiratory insufficiency, respiratory infection **benefit greatly from short periods of rest |
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Dx tests for MG |
Eyelids droop with exertion Tensilon test: hand is electronically stimulated over and over, EMG shows muscle fatigue, tensilon is injected, if muscles improve then + for MG |
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Tx for MG |
Drugs: Anticholinesterase drugs (free up receptor sites); alternate day corticosteroids, immunosuppressants Plasmapheresis (often done for short term benefits or prior to surgery or for pts in a myasthenia crisis; removes plasma from blood to remove anti-ACh receptor antibodies) Surgery: removal of thymus gland |
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Nursing Care of MG |
Patient education regarding choking risk (secondary to weak gag and intercostal muscles) Optimal nutrition secondary to impaired swallowing Optimal communication Self esteem (Secondary to pstosis, speech changes, role adjustment) Give high caloric value b/c they may wear out half way through the meal |
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A nurse instructs a patient with MG about home care and the risk factors that can exacerbate the disease. Which of the following patient statements indicates a need for further teaching?
A) I ordered a med ID bracelet and will wear it every day B)I have suction equipment at home in case I start to choke. C) I will soak in the hot tub every day. D)I should take my meds 45 minutes before breakfast, lunch, and dinner. |
Answer: C |
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Dementia |
Includes a plethora of disorders 8th leading cause of death in late life Most common: Alzheimer's disease (60%) Other forms: Vascular dementia (20%), Mixed types, fronto-temporal dementia, resulting from head trauma or anoxia |
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Alzheimer's Disease Manifestations |
Loss of recent memory Judgment problems Personality changes Deterioration of personal hygiene Progressive to long term memory loss |
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Alzheimer's disease (Characteristic and theories of causes) |
Characteristc: high concentration of beta-amyloid plaques; neurofibrillary tangles seen on postmortem examination Theories on causes: genetic mutations; environmental exposures, abnormalities in brain proteins or neurotransmitters |
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Alzheimer's Disease (Dx and nursing implications) |
Dx: by exclusion until the time of autopsy Nursing implications: risk of injury and/or wandering; coping for the patient and later the family; self-esteem early on; self care issues; care giver burden |
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When teaching the children of a patient who is being evaluated for AD about the disorder the nurse explains that... A) The most important risk factor for AD is a family hx of the disorder B) A dx of AD can be made only when other causes of dementia have been ruled out C)New drugs have been shown to reverse AD dramatically in some patients D) The presence of brain atrophy detected by MRI confirms the dx of AD in pts with dementia
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Answer: B |
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Consciousness |
Continuum of brain wave activity Can vary from : depression such as coma to hyperactivity such as a seizure |
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Determine Level of Consciousness |
Behavior: Measure with Glasgow coma scale; range is 3-15; 8 and below is a coma
EEG |
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Glasgow Coma Scale (Motor Response) |
6--Obeys commands fully 5--Localizes to noxious stimuli 4--Withdraws from noxius stimuli 3--Abnormal flexion, i.e. decorticate posturing 2--Exensor response, i.ed. decerebrate posturing 1--No response |
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Glasgow Coma Scale (Verbal Response) |
5--Alert and oriented 4--Confused, yet coherent, speech 3--Inappropriate words and jumbled phrases consisting of words 2--incomprehensible sounds 1--no sounds |
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Glasgow Coma Scale (Eye Opening) |
4--Spontaneous eye opening 3--Eyes open to speech 2--Eyes open to pain 1--No eye opening |
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Intracranial Pressure (ICP) (Definition and reasons for increased ICP) |
Hydrostatic force measured in the brain CSF compartment Reasons for Inc. ICP: hematoma, contusion, abscess, rapidly growing tumor, infection of the meninges |
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Increased ICP Complications |
Complications: inadequate profusion-->brain damage; cerebral herniation-->brainstem compression-->respiratory arrest!!!
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Cushing's Triad |
Bradycardia with bounding pulse Systolic HTN w/ widening pulse pressure Irregular respiration pattern |
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Clinical Manifestations of Inc. ICP |
Clinical Manifestations: Change in LOC (d/t dec blood flow); change in vital signs (subtle at first then cushing's triad); ocular signs (CN III compression --> dilation, NR, sluggish, inablilty to move eye upward and ptosis ipsilateral to lesion; fixed unilateral dilated pupil =hernation= NEURO EMERGENCY); dec motor function (coma when no response to pain); HA d/t pressure on arterial walls (occurs relentlessly but can worsen in AM and with straining); vomiting may not follow nausea; "unexpected vomiting" may also see projectile vomiting |
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Dx test fo inc ICP |
CT & MRI to find cause **lumbar puncture is not generally done on a person with increased ICP due to possible herniation b/c it could cause rapid pressure changes within the cranium |
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Inc ICP treatment |
Tx underlying cause Drug therapy: osmotic diuretic (Mannitol); corticosteroid (decadron) Nursing care: respect of pt; HOB 30 degrees; maintain airway and adequate oxygenation; avoid anything that would inc. ICP; nutrition; skin integrity; infection |
