Timby's Introductory Medical-Surgical Nursing: Peripheral Nervous System Disorders Flashcards

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Traumatic Brain injuries from concussion

ruptured cerebral aneurysm

stroke

obstructions in the circulation of CSF

infectious disorders of the nervous system such as a meningitis and encephalitis

Early signs of Increased Intracranial Pressure

Unresponsive

Glasgow Coma Scale<12

Decreased response to painful stimuli

Decorticated or Decerebrated posturing

Increased weakness or Hemiparesis

Dilated Pupil(s)

Seizures

Cushing triad: Bradycardia, elevated systolic blood pressure w/wide pressure, irregular breathing

loss of gag or corneal reflexes

period of apnea

Decreased Level of Consciousness (LOC)

Can be accompany by lethargic, stupors, semi-comatose, to comatose.

Confusion restlessness and periodic disorientation accompany decreased LOC

Swelling of the optic nerve

Cushing Triad

Skull radiography

CT, MRI

Lumbar Puncture

Cerebral angiography

Decreasing ICP by relieving the cause

Maintain BP, Prevent Hypoxia

Mechanical Ventilator

Client head maintain at midline of 30

True

Sedation w/ Barbiturates and propofol (helps with seizure)

Gather history of leading up to injury for client of witness, or technician,

Medical History

LOC/VS

assist with head -to toe exam

neurologic assessment q 30-60 min

obtain current and daily WT, I's and O's,

monitor electrolytes and ABG's

evaluate bowel sound and elimination

note evidence of seizures

Nursing care plan 37-1 610-612

Inflammation of the meninges caused by various infections microorganism

Bacteria, Viruses, fungi, or Parasites

Bacteria (meningococci and streptococci)

Viruses (HSV, Mumps, Enteroviruses)

Subarachnoid

Meningitis

Opisthotonos

Positive Kernig sign

flexion of the neck produces flexion of the knee and hips

Lumbar Puncture (on CSF) Cloudy (Bacterial)

Elevated CSF, Decrease Glucose concentration, Elevated Protein level

WBC and RBC are elevated

C&S to determine Bacterial causative

Viral C&S negative

CT, Blood culture, CBC rule out other poss. disorders

Hand Hygiene

Local Health department is notified of all cases

IV fluids

antimicrobial therapy (bacterial)

Penicillin, Cephalosporin, Rifampin (turn secretion orange) Ciprofloxacin, azithromycin or a IM dose of cefriaxone

Meningococcal meningitis

Haemophilus influenzae type b reduce the acquistion of bacterial meningitis

Inflammatory process affecting the CNS

Vector-borne viral infections

(St. Louis, western equine, eastern equine, West Nile)

Transmit by Ticks and Mosquitoes

Viral encephalitis

Lumbar puncture CSF elevated Fluid is Clear

West Nile blood or CSF show rise in IGM antibodies

EEG Slow waveforms

MRI, CT to rule out other etiologies

antipyretics

anticonvulsants

anti-inflammatory drugs and analgesics

Monitor VS and LOC frequently

Consult PCP if Indwelling catheter for urinary incontinence or urinary retention

Measure I's and O's (sign Fluid volume deficit) electrolyte imbalance

assess Bowel elimination to deter if stool softener or enema is needed

Measures to Control Exposure to Mosquitoes

acute postinfectious polyneuropathy, polyradiculoneuritis) affects the peripheral nerves and the spinal nerve roots.

exact cause of the disorder is unknown,

Is believed to be an autoimmune reaction

History of recent surgery

recent vaccination for viral disease(FLU)

• Acute inflammatory demyelinating polyradiculoneuropathy is most common (muscle weakness lower extremities and moves upward)
• (Viral) Miller fisher syndrome begin 1-4wks after infection begin with weakness in eye muscle and progressed down

Guillaun-Barre syndrome

Lumbar puncture reveal Elevated CSF, Protein level and Pressure

Electrophysiological test marked slow conduction of nerve impulses

• Plasmapheresis (remove plasma from the blood and reinfusion of the cellular components w/saline shorten the course of DX.)
• Administer IV immune globulin May enhance improvement
• Supportive treatment( gabapentin, amitriptyline or opioid to relieve discomfort
• Endotracheal intubation and mechanical ventilation
• IV fluids, gastric tub feeding or Parenteral Nutrition (PTN)

observe the client for respiratory distress

spirometer to evaluate the clients ventilation capacity

assess for pneumonia

check VS and lung sound frequently

provide meticulous skin care position change q2hours

help client perform active and passive exercises to prevent muscle atrophy

Collection of purulent material in the brain

Infection in the middle ear, sinuses or teeth or infection or organs

After intracranial surgery or head trauma

secondary to such disorders Bacterial endocarditis, bacteremia, Pulmonary or abdominal infection

Brain Abscess

Elevated WBC

CSF by lumbar confirms DX( risk for herniation of brain stem)

CT, MRI and Skull radiography are safer techniques for diagnosing and locating the abscess

Antimicrobial therapy once dx confirmed.

Craniotomy done to drain abscess

Cerebral edema and seizure treated with drug therapy

Control fever, mechanical ventilation, IV fluids and nutritional support

Assess frequently for altered LOC

change in sensory and motor functions

Sign of ICP monitors VS frequently

measures fluids I's and O's for overhydration that can leaded to Cerebral edema

Chronic progressive dx of the Peripheral nerves

Trigger by a defective genes

Cause permanent degeneration and destruction of myelin

Multiple Sclerosis

Lumbar puncture for CSF reveal increased WBC count

Electrophoresis of CSF reveal abnormal immunoglobulin G bsnd

CT MRI my or may not be discolsed lesion in the brains white matter

False there is no cure for MS, nor a single treatment that relieves all symptoms

Keep client functional as long as possible

Current research for promoting nerve regeneration

Medication use 1st dx's modifying drug Interferon beta-1a(avonex) Interferon beta-1b(betaseron), fingolimod(Gilenya)

Newer Drugs Immunosuppressive Alemtuzumab, Natalizunba, teriflunomide inhibit neurodegeneration

baclofen and dantrolene for muscle spasticity and rigidity

antibiotic for infection

tranquilizer alleviate mood swings

Oxybutynin and Botulinum toxin manage urinary incontienence

bethanechol use to relieve urinary retention

anti-inflammatory action of corticosteroids relieve symptoms and hastens remissions

Assess the client current physical and emotional status new developments or changes to previously assess

identifies the client visual problem emphasize that these may diminish when a remission occurs

listen to clients speech (rec. language board or assistive devices)

assess weight regularly blenderization of food in swallowing is impaired

Manage constipation with high fiber food and fluids

provide instruction concerning drug therapy

Neuromuscular disorder characterized by severe weakness of on or more groups of skeletal muscles

Most common in women

Cause is unknow

believed to be autoimmune in nature

Myasthenia Gravis

Myasthenic Crisis

IV administration of edrophonium (tensilon) relieve muscle weakness in a few seconds then dissipate in about 5 min

elevated acetylcholine receptor antibody titer

Chest radiography show enlargement of thymus(thymoma)

Electromyography measures the electrical potential of muscles

Administer Anticholinesterase (Pyridostigmine bromide) mestinon, (neostigmine) prostigmin or (ambenonium Chloride) mytelase facilitate normal neurotransmission

surgical removal of thymus gland

for client who don't response to therapy Prednisone or other immunosuppressant (azathioprine) Imuran TID a week

Myasthenic Crisis w/severe respiratory distress requires intubation and mechanical ventilation

Provide periods of rest

support ventilation by elevating the head of the bed and suction secretion w/difficulty in swallowing

make effort to understand the client when speech is compromises

demonstrates patience and empathy

administer medication at exact times to maintain therapeutic blood level

observe for signs of drug overdose (abd cramps, clenched jaws, muscle rigidity)

Progressive and fatal neurologic disorder

Common in men than women

Cause is unknown

Amyotrophic Lateral Sclerosis (Lou Gehring Disease)

Difficult to diagnose in the early stage No specific diagnostic test

Electromyography validated weakness in the affected muscles

no specific treatment, death occurs several years after Dx

encourage remain active as long as possible

Mechanical ventilation when ALS affect muscles of respiration

treated with riluzole slow progression and delay need for Trachestomy

Comprehensive assessment and plan of care on client basis problems

Provide assist with walking, bathing, shaving and dressing

teach family required skills ( suctioning, how to administer feeding tubes and catheter care

Medication schedule, adverse effects of medications
Dietary and feeding suggestions
Agencies that can help with or give home care
Sources of financial assistance
Exercises to prevent muscle atrophy
Positioning and good skin care
Techniques for preventing skin breakdown

Nursing process for client with chronic neuromuscular disorder 621-622

Painful condition that involves the 5th cranial nerve

3 major branches ( Mandibular maxillary and ophthalmic)

for Chewing facial movement and sensation

Unknown

Suggested it could be related to compression of the trigeminal nerve root

Trigeminal Neuralgia

Skull radiography, MRI or CT are preformed to rule out other pathologies

DX's is base on symptoms

Supportive and symptomatic

opioids

Anticonvulsants (phenytoin) Dilantin and (Carbamazepine) Tegretol reduce pain

Check toxicity level

Dentist referral correction of dental Malocclusion (relieve some cases)

Surgical division of sensory root of trigeminal nerve provides permanent relief

Nursing process for client with Trigeminal Neuralgia 623-624

Inspect the mouth daily for breaks in the mucous membrane.
Take small sips or bites of food and concentrate on chewing and swallowing if surgery has been performed.
Chew on the opposite side.
Avoid eating hot foods.
Use mouth rinses after eating.
Keep regular dental appointments because the warning pain of a cavity, abscess, or other dental problem may be mistaken for neuralgia.

involves the 7 cranial nerve that originates in the pons

Unknown, But viral link it suspected

Bell Palsy

No specific diagnostic tests

Based on symptoms and visual examination to the face.

Electromyography (EMG) Determine if any residual nerve and muscle activity

MRI or CT scan rule out other etiologies

Short-term high dose Corticosteroid therapy w/ prednisone Reduce nerve inflammation and edema

Antiviral acyclovir, Famciclovir or valacyclovir inhibit viral replication and shorten symptoms

B complex vitamin

Facial reanimation Improve facial movement and appearance

Nursing process for client with Bell palsy 625

Chew on unaffected side, protect eye with eye patch

Deficiency of Dopamine

The imbalance between dopamine and acetylcholine result in movement disorder

Parkinson Disease

High fiber crushed bran added to hot cereal and fiber-fortified supplement

prevent constipation w/fluids prunes and prune juice stimulate peristalsis

Taking levodopa should avoid high intake of protein decreasses it effectiveness

High protein diet for client with weight loss

Late stage Parkinson Diseases

Typical symptoms and neurologic examination

Aim to prolong independence

Drug Selegiline( Eldepryl) Levodopa (larodopa) levodopa-carbidopa (sinemet) Amantadine (symmetrel) Bromocriptine (parlodel) Apomorphinr (apokyn) Benztropine (cogentin)

Rehabilitation measures physical therapy occupational therapy client family education and counseling

Deep Brain Stimulation implantation of the neurostimulation Pacemaker for the brain

Gene therapy

Transplant of fetal dopamine neurons

Managing Client drug Therapy

Levodopa associated with periods of break through or end of dose wearing off

apomorphine help relieving the above

Help with walking OT and PT

small meals, difficult swallowing

37-2 and 37-1 some meds look at safety B6

Hereditary disorder of the CNS

Huntington disease

Base on the symptoms and family history

PET scan shows CNS changes

Genetic testing can predict which member will develop the disease

Treatment is supportive , No cure

Tranquilizers and antiparkinson drug relieve choreiform, movements in some clients

No drug available TO HALT THE MENTAL DETERIORATION

Genetic counseling before a pregnancy is advised

Help with ADL's were the client can do.

encourage client to lead a normal life,

Demonstrates how to use both hands to hold drink, use a straw to drink and wear slip on shoes

Increase risk for acquired infections especially if the client is catheterized

brief episode abnormal electrical activity in the brain

Convulsion symptom of a seizure (spasmodic) contractions of muscles

Epilepsy chronic recurrent pattent of seizure

Idiopathic

High fever

electrolyte imbalances

uremia

Hypoglycemia

hypoxia

brain tumor

drug abuse and Alcohol withdrawal

Partial Seizures

True

Generalized Seizure

Brief loss of Consciousness or Cognition during which physical activity ceases

Absence Seizures

Misidentified as a learning disability

Myoclonic seizures

Grand Mal seizures

happen before a seizure that could be vague emotional changes, depression, anxiety and nervousness.

Lasting for minutes of hours before a seizure

Sensation that occurs immediately before the seizure.

Sensory( Hallucinatory or odor or sound) or weakness or numbness

always the same

Epileptics Cry after the aura and it is the spasm of the respiratory muscles of the throat and glottis

after Cry the client will have LOC (tonic-Clonic phase)

Muscles contract rigidly in Clonic phase

Contraction and relaxation of muscle, jerking movement and thrashing of the arms and legs, skin cyanotic and breathing spasmodic

Saliva mixed with air (Frothing at the mouth

Jaws tight clenched, biting of the tongue and inner cheek my occur, urinary and fecal incontinence is common

Clonic phase last for 1 min or more

Period following the seizure client has Headache, Fatigue, Deep, sleep Confusion, Muscle soreness

After a tonic-Clonic a client does not regain consciousness between seizure.

If not treated Death can occur

Can be brought in by anticonvulsant abrupt stopping. Must be withdrawn gradually

LOC briefly and falls to the ground, recovery rapid (atonic)

Similar client may or may not fall and recovery rapid

Neurologic exam

EEG performed

CT, MRI, Serology and serum Electrolyte levels Confirm DX and determining cause of seizure

If EEG required if 1st on normal if epilepsy is suspected

• Anticonvulsant drugs use Phenytoin, Phenobarbital, Cabamazepine, Ethosuximide, Valproic acid, Felbamate, Gabapention and Fosphenytoin injection
• To terminate Epilepticus IV lorazepam, Diazepam, Midazolam. Alterated drug are IV fosphenytoin valproic acid or levetiracetam
• If seizure continue for 40 mins or more Thiopental or propofol my be required

Drug Therapy 37-2 633-634

Surgery only if client does not response to drug or the seizures are severe

Surgeon must consider if part of brain will cause neurologic dysfunction( paralysis) or loss of speech

Medical history and if they have seizures and treatment regimen

identifies client who may be prone to seizure

Promote safety (suction, oral airway, and oxygen equipment at the bedside, padded siderails and head board bed lowest position

administered and reinforces drug compliance

event of seizure

position client on side loosen restrictive clothing

airway keep patient, suction and oxygen if need

inspected for injuries to tongue, teeth, and buccal cavity

If incontinent clean the client and change linen

Document situation that lead up to seizure duration of seizure and parts of body involved, VS, Oxygen

Leads to calcium imbalance, rickets or osteomalacia if supplemental vitamin D is not given

High Fat diet

Growth of abnormal cells within the cranium

Congenital

Genetic factors

Viral infection

exposure to radiation

head trauma

immunosuppression

Brain tumor

CT scan, MRI, Brain scan, and Cerebral angiography show Tumor's size and location

Brain tumor Treat by surgery, radiation therapy, Chemotherapy,

Metastatic tumors some are inoperable, radiation therapy and Chemotherapy the only treatment choices

if cant do surgery are keep comfortable and free from pain as possible

to destroy or slow down tumor growth (intra-arterial or intrathecal)

symptomatic drug includes Corticosteroids and osmotic diuretics reduces cerebral edema, analgesics, anticonvulsants and antibiotics

Craniotomy incision through skull

Craniectomy excision of part of the skull

Noninvasive procedure for treating deep brain tumor or that conventional surgery can only partially remove

Laser procedure

Outpatient basis or 24 hour inpatient stay involves more than one procedure

Headaches, minor nausea after treatment , Temporary hair loss my occur if tumor is close to surface

Medication regimen
Appointments for chemotherapy or radiation therapy
Adverse effects of chemotherapy or radiation and techniques for managing them
Nutritional support
Home care considerations
Rehabilitation (exercises, physical therapy)
Referrals to support services for physical, emotional, and financial assistance