St.

Paul College of Ilocos Sur

(Member: St. Paul University System)
St. Paul Avenue, 2727 Bantay, Ilocos Sur

DEPARTMENT OF NURSING

Name: Charina Aubrey Riodil Instructor: Melanio P. Rojas Jr MAN Score: _______________
Section/Year Level:BSN-II Serviteurs Defenseurs De Saint Joseph Date: March 20, 2020

Nursing Care of Neurologic

Part 1 Complete the following fill-in-the-blank exercises.

1. The nervous system consists of two separate systems, the

and the nervous system.

2. Tests for cerebellar function involve testing for normal

and .

3. Indicate of the following actions test reflex, sensory, motor, or

cerebellar function:

A. asking a child to touch each finger on one hand

with the thumb of that hand is rapid succession

test.

B. Asking a child to resist your action as you push

down or up on his hands.

C.

D. striking a child’s wrist with a rubber hammer.

Nursing Care of Neurologic

 4. The rate at which symptoms of intracarnial pressure develop

depends on the , and on whether the child’s

skull can to accommodate the pressure.

5. Signs of , in which a child is unsure of time and

place, may be the first indication of increased intracranial

pressure.

6. Cerebral perfusion pressure is calculated by subtracting the mean

intracranial pressure from the mean pressure.

7. The major cause of meningitis in newborns is the group is

hemolytic

organism.

8. The treatment for infant botulism consists of

9. Convulsion associated with high fever are most common in

between months and

years of age.

10. Identify the seizure described below as either psychomotor, focal,

absence, tonic-clonic, or status epilepticus.

A. generalized seizures with a prodromal, aural,

tonic, and clonic stage

B. convulsions occurring in rapid succession

without pause

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 C. begins with localized activity, may or may not

spread

D. may begin with a sudden change in posture,

circumoral pallor, 5 minute loss of

consciousness without a postictal stage.

E. “petit mal,” generalized seizures involving a

staring spell lasting for a few seconds.

Part 2 Complete the following short answer exercises.

1. Describe one method of assessing a child for the function of five of

the following cranial nerves: 1, 2, 3, 5, 7, 8, 9, 10, 11, and 12.

1st Cranial nerve Smell, a function of the 1st (olfactory) cranial nerve,
is usually evaluated only after head trauma or when lesions of the
anterior fossa (eg, meningioma) are suspected or patients report
abnormal smell or taste.
2nd Cranial nerve visual acuity is tested using a Snellen chart for
distance vision or a handheld chart for near vision; each eye is
assessed individually, with the other eye covered. Color perception is
tested using standard pseudoisochromatic Ishihara or Hardy-Rand-
Ritter plates that have numbers or figures embedded in a field of
specifically colored dots. Visual fields are tested by directed
confrontation in all 4 visual quadrants. Direct and consensual pupillary
responses are tested. Funduscopic examination  is also done.
For the 3rd (ocolomotor), 4th (trochlear), and 6th (abducens)
cranial nerves, eyes are observed for symmetry of movement, globe

Nursing Care of Neurologic

position, asymmetry or droop of the eyelids (ptosis), and twitches or
flutters of globes or lids. Extraocular movements controlled by these
nerves are tested by asking the patient to follow a moving target (eg,
examiner’s finger, penlight) to all 4 quadrants (including across the
midline) and toward the tip of the nose; this test can detect nystagmus
and palsies of ocular muscles. Brief fine amplitude nystagmus at end-
lateral gaze is normal.
For the 5th (trigeminal) nerve, the 3 sensory divisions
(ophthalmic, maxillary, mandibular) are evaluated by using a
pinprick to test facial sensation and by brushing a wisp of cotton
against the lower or lateral cornea to evaluate the corneal reflex. If
facial sensation is lost, the angle of the jaw should be examined;
sparing of this area (innervated by spinal root C2) suggests a
trigeminal deficit. A weak blink due to facial weakness (eg, 7th cranial
nerve paralysis) should be distinguished from depressed or absent
corneal sensation, which is common in contact lens wearers. A
patient with facial weakness feels the cotton wisp normally on both
sides, even though blink is decreased. Trigeminal motor function is
tested by palpating the masseter muscles while the patient clenches
the teeth and by asking the patient to open the mouth against
resistance. If a pterygoid muscle is weak, the jaw deviates to that side
when the mouth is opened.
The 7th (facial) cranial nerve is evaluated by checking for hemifacial
weakness. Asymmetry of facial movements is often more obvious
during spontaneous conversation, especially when the patient smiles
or, if obtunded, grimaces at a noxious stimulus; on the weakened
side, the nasolabial fold is depressed and the palpebral fissure is
widened. If the patient has only lower facial weakness (ie, furrowing of

Nursing Care of Neurologic

 the forehead and eye closure are preserved), etiology of 7th nerve
weakness is central rather than peripheral. Taste in the anterior two
thirds of the tongue can be tested with sweet, sour, salty, and bitter
solutions applied with a cotton swab first on one side of the tongue,
then on the other.
The 8th cranial nerve hearing; balance.
The 9th (glossopharyngeal) and 10th (vagus) cranial nerves are
usually evaluated together. Whether the palate elevates symmetrically
when the patient says "ah" is noted. If one side is paretic, the uvula is
lifted away from the paretic side. A tongue blade can be used to touch
one side of the posterior pharynx, then the other, and symmetry of the
gag reflex is observed; bilateral absence of the gag reflex is common
among healthy people and may not be significant.
The 11th (spinal accessory) cranial nerve is evaluated by testing
the muscles it supplies: For the sternocleidomastoid, the patient is
asked to turn the head against resistance supplied by the examiner’s
hand while the examiner palpates the active muscle (opposite the
turned head). For the upper trapezius, the patient is asked to elevate
the shoulders against resistance supplied by the examiner.
The 12th (hypoglossal) cranial nerve is evaluated by asking the
patient to extend the tongue and inspecting it for atrophy,
fasciculations, and weakness (deviation is toward the side of a
lesion).

2. Describe a method to assess an infant’s level of consciousness

The Paediatric Glasgow Coma Scale (English) (also known as Pediatric

Glasgow Coma Score (American English) or simply PGCS) is the equivalent

Nursing Care of Neurologic

of the Glasgow Coma Scale (GCS) used to assess the level of consciousness

of child patients. As many of the assessments for an adult patient would not

be appropriate for infants, the Glasgow Coma Scale was modified slightly to

form the PGCS. As with the GCS, the PGCS comprises three

tests: eye, verbal and motor responses. The three values separately as well

as their sum are considered. The lowest possible PGCS (the sum) is 3 (deep

coma or death) whilst the highest is 15 (fully awake and aware person). The

pediatric GCS is commonly used in emergency medical services.

3. Discuss three modifications needed to assist a child with cerebral

palsy to maintain adequate nutritional intake.

4. Name two possible causes of seizure in newborns, infants and

toddlers, and children over age 3 years.

Neonatal seizures can have many causes, including lack of oxygen before or

during birth, an infection acquired before or after birth, bleeding in the brain,
blood sugar or electrolyte imbalances or drug withdrawal.
Infants seizures most common cause of seizures in newborn infants is
hypoxic-ischemic encephalopathy, or HIE and Meningitis etc.

5. Discuss the differences between migraine headaches and other

headaches.

Nursing Care of Neurologic

Part 3 Match the terms in Column I with a definition or related statement from

Column II. Place the letter corresponding to the answer in the space provided

(use each letter once only, some letters may not be used).

Column I Column II

1. decerebrate posturing A. pain on flexing the knee when the

thigh is bent on the abdomen

2. diplegia B. subcutaneous tumors along

nerve pathways with excessive

skin pigmentation and possible

optic or acoustic nerve degeneration

3. electroencephalogram C. the ability to recognize a shape that

has been traced on the skin

4. graphesthesia D. may require sedation for accurate

measurement of the electrical

patterns of the brain

5. kinesthesia E. the ability to distinguish movement

6. kernig's sign F. child’s arms are adducted and

flexed on the chest with wrists flexed

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7. neurofibromatosis G. resistance to neck flexion with hack

arching and neck hyperextension;

indicative of meningitis

8. opisthotonus H. the ability to recognize an object by

touch

9. stereognosis I. characterized by rigid extension and

pronation of the arms and legs

10. sturge-weber syndrome J. involves the trageminal nerve and d

estruction of motor neurons on the

side of the face opposite a port

wine stain

K. Involves paralysis of both the

extremities on one side of the body

SECTION TWO

Critical Thinking for Application of Essential Concepts

Part 1

1. Melle, age 7, is admitted to your unit after an automobile accident. You

would suspect increased intracranial pressure if your assessment

revealed which of the following?

Nursing Care of Neurologic

 A. bradycardiac rhythm

B. decreased pulse pressure

C. hypotensive blood pressure

2. A doll’s eye reflex:

A. can be used to assess a comatose child neurologically

B. indicates increased intracranial pressure

C. is revealed when a child turns his eyes to the left when his head is

turned to the left rapidly.

D. represents an abnormal neurological finding.

3. Billy, ages 2, has been diagnosed with cerebral palsy. the nurse should

explain which of the following to Billy’s parents?

A. Cerebral palsy involves a progressive nerve degeneration.

B. Contractures are unavoidable since ambulation is impossible.

C. The brain damage that occurred at birth can be repaired with

surgery when the child is older.

D. Two children with cerebral palsy may exhibit totally different

symptoms and abilities

4. A child with Guillain- Barre syndrome will require which of the following

nursing interventions?

A. feeding the child orally to maintain the muscles of mastication

B. explaining to parents that steroids will be effective in halting the

paralysis

C. immobilizing extremities to decrease stimulation of muscle spasm

D. inserting a Foley catheter into the bladder to monitor urine output

Nursing Care of Neurologic

5. To decrease the incidence of spinal cord injury in children and

adolescents, the nurse should do which of the following?

A. Caution children and adolescents against diving into shallow water.

B. Encourage the intake of vitamin A and C to minimize spinal cord

injury.

C. Instruct adolescents to ride motorcycles instead of driving cars.

D. Teach back exercises to children to strengthen their weak

vertebrae.

6. A child with a cervical spinal injury should be watched very carefully for

which of the following?

A. diarrhea and hypoactive bowel sounds during the second recovery

phase

B. hyperreflexia of the bladder during the first recovery phase

C. profuse diaphoresis during the second recovery phase

D. respiratory distress during the first recovery phase

7. Which of the following are signs of anatomic dysreflexia?

A. bradycardia and flushed face

B. headache and hypertension

C. hypertension and pallor

D. pale skin and dizziness

8. Which of the following is true about the third phase of spinal cord

recovery?

A. Autonomic dysreflexia is a common occurrence

B. Spasticity of muscles and reflexes is noted.

Nursing Care of Neurologic

 C. Flaccid paralysis of the diaphragm and skeletal muscles is present.

D. Permanent limitation of motor and sensory function can be

assessed.

9. Benje, age 7, is admitted to the emergency room with suspected spinal

cord injury after an automobile accident. which of the following nursing

interventions would be appropriate?

A. Move the child from the admission stretcher to a firm examining

table on admission.

B. Hyperextend the head if respiratory resuscitation is necessary.

C. Remove any hard head coverings and replace with a support neck

brace.

D. Maintain spinal immobilization during neurological assessments.

10. Nursing care of the spinal cord client may include which of the following

interventions?

A. pushing carbonated beverages during the first phase of recovery to

acidify urine

B. using Crede’s maneuver to establish a defecation pattern

C. helping the child and family to adjust to permanent mobility loss

during the first recovery phase.

D. supporting the child and family during the grieving process after the

second recovery phase.

Part 2 Determine if the following nursing interventions are appropriate or

inappropriate. Indicate your answer by placing an A or an I in the space

provided.

Nursing Care of Neurologic

1. preparing a child with a suspected elevation of cerebral spinal fluid

pressure for a lumber puncture.

2. pushing fluids after a lumbar puncture to reduce spinal headache

3. positioning a child flat in bed following myelography

4. monitoring a child undergoing an EEG for a possible seizure by use

of the whirling disk

5. performing coughing exercises each hour with a child with increased

intracranial pressure to keep chest clear

6. placing children with meningitis on respiratory isolation for 24 hours

of antibiotic therapy to prevent spread of the infection

7. teaching parents of children with meningitis to provide care and use

proper isolation techniques.

8. explaining to parents of a child with viral encephalitis that antibiotics

will cure the infection

9. instructing the parent of a child with Reye’s syndrome that the

condition will run its course and requires no special treatment

10. teaching parents of children with seizures to place the child in a tub

bath after a seizure episode to remove perspiration

Nursing Care of Neurologic