Flashcards › Neuro Exam- DNI MED SURG II

What are the two anatomic divisions? The central nervous system (CNS) and the peripheral nervous system (PNS) The is the basic structure of the nervous system? the nerve cell or neuron dendrites a nucleus, and threadlike projections or fibers and conduct impulses to the cell body axon a nerve fiber that projects and conducts impulses away from the cell body The uncontrollable writhing and twisting movements of the body in Huntington's disease are called ______________________ movements. Choreiform Clients taking ______________________ should be advised against high intakes of protein and vitamin B6. Levodopa Loss of sympathetic reflex activity below the level of injury within minutes of a spinal injury is called ______________________. Areflexia Swelling and herniation of the spongy center of the vertebrae, the nucleus pulposus, caused by poor body mechanics, age, or disease is termed ______________________. Slipped disk During the assessment of a client with a neurological deficit, the nurse reports a urinary output of less than ______________________. 500 mL/d The nurse must keep the room dark and quiet after a lumbar puncture or ______________________ because sensory stimulation magnifies discomfort for the client. Myelogram he incidence of __________decreases with age. Brain tumor It is possible for a ________to accompany a skull fracture. hematoma Normal cerebral perfusion pressure (CPP) ranges from ____________. 70 to 100 mm Hg. What does (PET) an imaging procedure. Positron emission tomography is an imaging procedure Cisternal puncture, to remove CSF, is performed more commonly on __________. children A _____________ dilates an artery whose lumen has been decreased. balloon angioplasty The procedure to remove a ruptured disk Diskectomy The technique that electrically separates and identifies proteins, demonstrates abnormal immunoglobulin G bands, described as oligoclonal bands, in CSF Electrophoresis A potentially fatal neurologic problem that is accompanied by one pupil that responds more sluggishly than the other or becomes fixed and dilated IICP A technique that involves the client bending at the waist or pressing inward and downward over the bladder to promote urination Credé's maneuver A collective term for the neurotransmitters produced by the sympathetic nervous system Catecholamines A type of migraine, occurring primarily in young women, accompanied by dizziness, diplopia, and impaired coordination Basilar artery migraine Spinal shock related symptoms Poikilothermia Cervical spinal injury related symptoms Tetraplegia Autonomic dysreflexia related symptoms Severe hypertension Skull fracture related symptoms Periorbital ecchymosis Herniated intravertebral disc related symptoms Paresthesia Tension headache Relaxation exercises modes of treatment CVA Tissue plasminogen activator modes of treatment Cerebral aneurysm Aminocaproic acid modes of treatment Cluster headache Serotonin enhancer modes of treatment TIA Balloon angioplasty modes of treatment Migraine headaches Biofeedback techniques modes of treatment Epidural Hematoma- Location, Signs and Symptoms Arterial blood collects between the skull and the dura.--Common symptoms include headache, ipsilateral pupil change, and contralateral hemiparesis. Subdural Hematoma -Location, Signs and Symptoms Venous blood collects between the dura and subarachnoid layers.--Common symptoms include ipsilateral pupil change, decreased extraocular muscle movement, and contralateral hemiparesis, with periodic lapses of memory, confusion, drowsiness, and personality changes Intracerebral Hematoma -Location, Signs and Symptoms Blood collects within the brain.--Classic signs of IICP include headache, vomiting, seizures, posturing, hyperthermia, and irregular bleeding. List a few signs of the tonic and clonic phases during a generalized seizure. In the tonic phase, the muscles contract rigidly. In the clonic phase, the muscles alternate between contraction and relaxation, resulting in jerking movements and thrashing of the arms and legs. The skin becomes cyanotic; breathing is spasmodic. Saliva mixes with the air, resulting in frothing at the mouth. The jaws are tightly clenched, with biting of the tongue and inner cheek. Urinary or fecal incontinence is common. Other manifestations include headache, fatigue, deep sleep, confusion, nausea, and muscle soreness. Many people fall into a deep sleep for several hours. Why is skin traction used in clients with spinal nerve root compression? Skin traction is used to decrease severe muscle spasm, increase the distance between the adjacent vertebrae, and keep the vertebrae correctly aligned. Name the complications associated with an intracranial surgery. Complications associated with an intracranial surgery include cerebral edema, infection, neurogenic shock, fluid and electrolyte imbalances, venous thrombosis, IICP, seizures, leakage of cerebrospinal fluid, and stress ulcers and hemorrhage. Describe the assessment of a client with a neurological deficit. Obtain a thorough history from the client or family. Assess vital signs and level of comfort. Perform a general neurologic assessment. Inquire about any seizures and get a description of those that occurred. Evaluate the airway, breathing, circulation, and the LOC. Inspect the skin, auscultate the abdomen for bowel sounds, palpate the bladder for distention, and determine the client's ability to control his bowel and bladder. Explore the client's emotional and mental status and motivation for rehabilitation. What is an aura as it relates to a migraine headache? When does it occur and in which type of migraine? An aura is a sensory phenomenon that precedes the migraine headache by approximately 10 to 30 minutes. Some clients have visual disturbances, such as flashing lights or wavy lines; some develop weakness or tingling in an extremity; others become confused or have difficulty speaking. For those with the more “common” form of migraine, the prodromal period before the headache is marked by a change in mood, difficulty in concentrating, or unusual fatigue. The aura occurs in “classic” migraines. List the signs of an impending stroke. The signs of an impending stroke include numbness or weakness of one side of the face, an arm, or leg; mental confusion; difficulty speaking or understanding; impaired walking or coordination; and severe headache. Why do healthcare professionals currently question the use of barbiturate coma therapy in clients with IICP? Barbiturate coma therapy lowers metabolic brain requirements, and the resultant sedation contributes to hypotension, pneumonia, hypoxia, and respiratory depression. Why is correct emergency management at the time of an injury so crucial for a client with spinal cord trauma? Moving the client incorrectly can permanently damage the spinal cord. Even with no fracture, edema may lead to cord compression that may permanently damage the cord. When a portion of the lumbar spine is fused, the client usually does not feel the stiffness after a short time. Why? Motion increases in the joints above the fusion. Why should visitors, except family members, be restricted from the bedside of a client being treated for a ruptured cerebral aneurysm? A client with a ruptured cerebral aneurysm is advised strict bed-rest without disturbance. In addition, the head of the bed is elevated to reduce ICP and cerebral edema in the client. Complete bed rest, the prevention of re-bleeding at the rupture site, and the treatment of complications are the primary goals. Absolute bed rest in a quiet area, preferably a private room, is very essential. Therefore, visitors other than family members are restricted from the bedside of the client. Kelly, age 12, falls and hurts her head against a stone while playing. She has a brief lapse of consciousness; her mother brings her to the hospital. After a thorough assessment, Kelly is discharged with specific instructions. What instructions should the nurse give to Kelly and her mother at the time of discharge? Watch the client closely for signs of increased intracranial pressure (IICP). Common signs of IICP include behavioral alterations, sleepiness, personality changes, vomiting, and speech or gait disturbances. Contact a physician or return to the emergency department (ED) if any of these symptoms occur A female client, 65 years old, complains about tremors she feels quite frequently in her fingers. The client wants to know if these could be from aging or the onset of Parkinson's disease. Briefly describe the early signs of Parkinson's disease that will help confirm the disorder. Early signs of Parkinson's disease include stiffness, referred to as While caring for a client with impaired physical immobility, what precautions should the nurse take to minimize the risk for disuse syndrome? Position the client to avoid joint contractures and foot drop. Help the client perform exercises identified by the physical therapist. Apply leg braces when ambulation is possible. Maintain skin integrity by changing the client's position at least every 2 hours, using pressure-relieving devices, massaging skin over bony prominences that blanch with relief of pressure, and keeping skin clean and dry. Facilitate urine elimination; keep the bowel evacuated. Keep the client hydrated. Provide oral or enteral nutrition A client with a neurological deficit is to return home with life-altering changes. What interventions can the nurse use to help prepare the client and the family to adapt to the new lifestyle? Listen and be alert to subtle hints about the client's and family's adaptation to the client's change in functional status. Ask direct questions to identify problems and needs. Evaluate the client's ability to perform self-care, resume his or her role in the family, and call on a support system. Take appropriate steps to help the client and family attain and maintain a home life as near normal as possible. Encourage the family to help plan for the client's return to home, to ask questions about care, and to seek assistance from those agencies that can provide emotional, physical, and financial support. To obtain CSF samples for a culture examination, a lumbar puncture has been performed on a client with meningitis. The nurse needs to monitor and care for the client after the procedure. List the various post-procedure care tasks a nurse needs to perform related to a lumbar puncture. Inspect injection sites, especially those made during a lumbar puncture, for signs of a hematoma. Position the client flat for at least 3 hours or as directed by the physician. Encourage a liberal fluid intake. Keep the room dark and quiet. Administer a prescribed analgesic if the client develops a headache. Report the onset of a headache and a sudden or severe pain in any area of the body to the physician immediately. During the dietary assessment for a client with migraines, explain the importance of maintaining a journal or diary of food intakes? Counseling the client with migraines to maintain a detailed journal or diary of foods is important because this practice helps identify food items that trigger the headaches. The client may then eliminate their consumption, thereby preventing migraines gradually. For a client with a cerebrovascular accident (stroke), what essential points should the nurse include in the client's family teaching? Administer medications as directed and understand the potential side and adverse effects. Implement eating and swallowing techniques that reduce the potential for aspiration. Perform the Heimlich maneuver to clear the airway if the client cannot speak or breathe after swallowing food. Continue follow-up care with the speech pathologist and dietitian. Contact community resources, such as the medical supply companies that rent or sell special care devices, such as a hospital bed, bedside commode, walker, or tripod cane. Remove throw rugs, clutter, and electrical cords from the client's home environment to reduce the potential for falls. Perform regular exercises, change the client's position frequently, and apply braces or splints designed to maintain extremities in a proper anatomic position. Which of the following is the most important reason for the nurse to closely monitor a client's body temperature after intracranial surgery? Hyperthermia increases the risk for brain damage. A client is undergoing intracranial surgery. Which of the following interventions is most important to prevent the complications of thrombophlebitis and deep vein thrombosis? Apply antiembolism stockings. To prevent thrombophlebitis and deep vein thrombosis in a client, which may develop from prolonged inactivity during neurosurgery, the nurse applies antiembolism stockings. Before performing surgery, the nurse restricts fluids to avoid intraoperative complications, reduce cerebral edema, and prevent postoperative vomiting. Depending on the client's level of consciousness, preoperative sedation may be prescribed. Corticosteroids may be administered, but the purpose is to reduce intracranial swelling rather than prevent thrombophlebitis or deep vein thrombosis. Older adults generally do not exhibit the typical signs and symptoms of meningitis. Which of the following signs and symptoms would the nurse be especially vigilant for in older clients with suspected meningitis? No nuchal rigidity or headache,Change in mental status -- Older adults with meningitis may display a change in mental status, slight or no fever, and no nuchal rigidity or headache. Pressure ulcers and hypostatic pneumonia develop as a result of prolonged immobility or lack of activity during old age. On the other hand, papilledema or swelling of the optic nerve is caused by an interference with venous drainage from the eye. A nurse uses the Glasgow Coma Scale to measure the client's level of consciousness. Which of the following methods can the nurse use to evoke and assess the best verbal response from the client? Note the client's responses to general orientation questions. Using the Glasgow Coma Scale to evaluate the “best verbal response” from a client, the nurse must evoke verbal replies to general questions. None of the other methods presents a specific stimulus for generating a verbal response from the client. By calling out the client's name, the nurse may note the client's reaction and evaluate his or her “best eye response,” but not necessarily his or her “best verbal response.” Which of the following nursing interventions best facilitates functional use of the limbs of a client with musculoskeletal inactivity and neuromuscular impairment? Keep extremities aligned with pillows, trochanter rolls, and splints. Which of the following interventions would be most appropriate for managing and minimizing seizures when caring for a client with a neurologic infectious disorder? Provide oxygen during and after the seizure. The nurse should provide oxygen during and after the seizure. Hypoxemia develops when the client's diaphragm contracts and breathing is irregular throughout the seizure. The nurse should not restrain client's movements. Doing so during a seizure can cause fractures or other musculoskeletal injuries. The nurse should suction the client's mouth and pharynx after the seizure and not during the seizures. Suctioning clears accumulated secretions from the airway. The nurse should not place the client in supine position. The nurse should turn the client to the side during a seizure. A lateral position reduces the potential for aspiration of saliva or stomach contents. Which of the following measures would the nurse suggest to a client who experiences frequent tension headaches? Using guided imagery,Resting in a quiet environment,Performing relaxation exercises,Relying on effective coping skills-- These options help the client to prevent or control tension headaches. Basically, all efforts to ensure a serene and calm environment should be made to manage the tension headache. The movement of air by the fan may, as an external stimulus, aggravate the headache. During a tension headache, the client will not be in a position to watch television, and the eye strain may make matters worse. What three parts is the brain divided into? the cerebrum, the cerebellum, and the brain stem. corpus callosum a band of white fibers that acts as a bridge for transmitting impulses between the left and right hemispheres medulla oblongata lies below the pons and transmits motor impulses from the brain to the spinal cord and sensory impulses from peripheral sensory neurons to the brain The __________ contains vital centers concerned with respiration, heartbeat, and vasomotor activity (the control of smooth muscle activity in blood vessel walls). medulla The brain is protected by the rigid bones of the skull and covered by ________________. meninges The ___________ manufacture and absorb cerebrospinal fluid (CSF), which constantly circulates in the subarachnoid space of the brain and spinal cord. ventricles What are the the three meinges (membranes)? dura mater:tough outermost covering -- arachnoid : middle -- pia mater : delicate Sympathetic Nervous System / NEUROTRANSMITTERS ARE CATECHOLAMINES neurotransmitters are catexholamines: epinephrine, norepinephrine, and dopamine Glasgow coma scale a tool for assessing a client's response to stimuli. A score of 10 or less indicates a need for emergency attention: a score of 7 or less is generally interpreted as coma. A normal response is 15. Dilation or constriction of cerebral blood vessels in response to changes in: Blood pressure, blood Oxygen levels, blood pH -- maintain constant and consistent tissue perfusion