Exam 6- Study Guide

Neurologic

 Lumbar puncture (1 question)

o Post-procedure complications= HA d/t changes in cerebral spinal fluid;
how to help them decreaselie down flat (decreased ICP) & medicate for
pain
o Prevention
 Cranial nerves (VIII) (1 question)
***vestibulocochlear nerve (hearing and balance) = Meniere’s disease is a
vestibulocochlear nerve condition; can’t eat a lot of salt, get vertigo!!
 Neurologic assessment (2 questions)
o Confirm brain death EEG (electroencephalogram)
o What is needed by the nurse to be able to a thorough nerve
assessmentGlasgow, lumbar puncture, CT, MRI
 Diagnostic testing (2 questions)
o CT scan- pre-procedure education= lie still, feeling of peeing, check for
allergy to iodine/shellfish, metformin, 4 hr fasting
o MRI- pre-procedure= implants/metals, medication patches,
claustrophobic, long (30 min)
 ICP (3 questions)
o Nursing actions= how to calculate cerebral perfusion pressure
MAP-ICP= CPP (70-100 normal; under 70 bad; anything less than 50 is
permanent brain damage)
o Increased ICP
 Nursing interventions= gives me dx and wants me to give
intervention for dx (nursing process in ch. 66 for ICP pg. 1984
REVIEW!!!)
1. Maintain patent airway (suctioning)
2. Adequate breathing pattern (hyperventilation therapy)
3. Optimize cerebral tissue perfusion (30 degree head,
diuretics, stool softener, low PEEP, & O2 therapy
***NO VALSALA MANUEVER
4. Negative fluid balance (diuretics)
5. Prevent infection
6. Monitoring complications ( Brain herniationdeath)
 o Complications = monitor in head that tells me pressure; with this patient
that has monitor in brain risk for infection meningitis or encephalitis
 Head trauma (2 questions)
o Epidural Hematoma and how we treat them  make burr holes (openings
to dec ICP, remove clot & control bleeding) & craniotomy (remove clot &
control bleeding); drain inserted to prevent reaccumulating of blood
o LOC different types; scenarioyou have a pt who has a head trauma …
displaying this….what is their current LOC?
*Coma: prolonged state of unconsciousness
*Akinetic mutism: unresponsiveness to the environment; the patient
makes no movement or sound but sometimes opens the eyes
*Persistent vegetative state: condition in which the patient is wakeful but
devoid of conscious content, without cognitive or affective mental
function
*Minimally conscious state: a state in which the patient demonstrates
awareness but cannot communicate thoughts or feelings
*Locked-in syndrome: condition resulting from a lesion in the pons in
which the patient lacks all distal motor activity (paralysis) but cognition is
intact

a) stuporous
b) obtunded
c)lethargic
d)comatose
e) restlessness
 Malignant Hyperthermia (1 question)
o Pathophysiology= what part of the brain regulates temperature
hypothalamus
 Seizures (4 questions)
o Nursing management= bed low, airway kit, lie patient on side
o Treatment= Benzos, anticonvulsants (dilantin), gabapentin, phenytoin,
o Post ictal state= sleepy and out of it!!!
o Documentation of seizure= triggers, interventions, duration
 Glascow coma scale (3 questions) ch. 68 pg. 2039
 o Scores= open eyes to pain, inappropriate verbal sounds, withdrawal from
pain…..what score 9
o Interpretation= given score…this what they’re doing now- are they better
or worse?
o Documentation= how do we assess LOC? GLASCOW COMA SCALE
 Subdural hematoma (1 question)
o Causes HTN, anticoagulants!!!
 Autonomic dysreflexia (1 question) PP
o Clinical manifestations= SEVERE POUNDING HA, bradycardia, HTN,
Nausea, diaphoresis, stuffy nose
 Intercranial surgery (3 questions)
o Post Complications= increased ICP, bleeding and hypovolemic shock F&E
disturbances, infection, CSF leak, and seizures
o Nursing interventions= pain management after brain surgery
o Anatomy of the head
o Changes in LOC
o Transsphenoidal surgery (through the nose right into the brain) offers
direct access to the sella turcica with minimal risk of trauma and
hemorrhage (Bader et al., 2016). It avoids many of the risks of craniotomy,
and the postoperative discomfort is similar to that of other transnasal
surgical procedure
 Spinal cord injury (2 questions)
o Neurogenic shock
 o Clinical manifestations= paraplegia, tetraplegia, acute back or neck pain
o Complications=pneumonia, pressure ulcers, DVT, PE, infection,
autonomic dysreflexia, and spinal & neurogenic shock
 Multiple Sclerosis (3 questions)
o Clinical manifestations= vision problems, coordination issues, weakness,
fatigue, swallowing, balance issues
o Education= safety (assistive devices), fatigue, ADL’s, disease process, IM
or SQ med administration, exercises, new home settings
o Plan of care= interferons, acetate, & IV methylpresodone

 Guillan- Barre (4 questions) ***all have to do with breathing!!!

--------****ascending paralysis
o Nursing interventions = mech ventilation, suctioning, and medications
o Complications= lose the ability to breathe d/t loss of diaphragm,
prioritizing!
 Myasthenia Gravis (3 questions)
o clinical manifestations= diplopia & ptosis (EYES), facial weakness, voice
impairment (dysphonia), and generalized weakness.
o nursing care= pg 2081; weakness & fatigue. HOW and WHEN do we
provide care
o medications= anticholinerstase medication to reducing and removing
circulating antibodies, thereby improving function. Plasmapheresis &
Thyrectomy.
o Teaching= avoid triggers
 ALS (1 question) ch. 70
o Diagnosis= electromyography, muscle biopsy, MRI, & neuropsychological
testing; diagnosed on the basis of the signs and symptoms
 Parkinson’s Disease (5 questions) pg. 2101
o Assessment change such as stooped posture; a stiff arm; a slight limp;
tremor; or slow, small handwriting
o Nutritional needs= increased caloric intake; need for NG tube or PEG tube
may be necessary to maintain adequate nutrition
o Medications Levadopa Carbidopa)
 Side effects= on off syndrome (periods of immobility)
o Education (home care)
 o Delegation of care= you are the nurse and you have a pt who has PD,
which of the following task would you assign to the unlicensed personnel
 Subarachnoid hemorrhage (1 question)
o Treatment (brain hemorrhage is a brain hemorrhage)= management of
HTN
 Angiogram (labs which one should you call the doctor about; kidney function) (1
question)
o Pre-procedure= BUN & CR; platelet count
 Basilar skull fracture (1 question)
o Clinical manifestations=battle sign (bruising on mastoid bone), raccoon
eyes, otorrhea, rhinorrhea, cranial nerve #1

***Meningitis (pg. 2068) (3 questions)

-how we assess them, relieve s/s…

-treatment for bacterial meningitis= Dexamethasone

-nursing interventionsprecaution until 24 hr after AX therapy initiation,

pain management, quiet/dark room, treat elevated temp, stay hydrated,
neurologic monitoring

Dosage calculations