Neurological System
Describe babinski sign
p. 848- is a dorsiflexion of the great toe and fanning of the other toes, is abnormal in anyone older than 2 years and represents the presence of central nervous system disease
Define Parkinsons disease
p. 868- is a progressive neurodegenerative disease that is one of the most common neurologic disorders of older adults. It is a debilitating disease affecting mobility
Define CVA versus TIA
p. 927- transient ischemic attack (TIA)- temporary neurologic dysfunction resulting from a brief interruption in cerebral blood flow. Symptoms resolve within 30-60 minutes
p. 928- cerebrovascular accident (CVA)-caused by an interruption of perfusion to any part of the brain
Define epilepsy
p. 876- two or more seizures experienced by a person. It is a chronic disorder in which repeated unprovoked seizure activity occurs
What is myasthenia gravis
p. 917- is an acquired autoimmune disease characterized by muscle weakness. There are two types of MG: ocular and generalized
What is an EMG and why is it ordered?
p. 854- Electromyography- used to identify nerve and muscle disorders as well as spinal cord injuries.
List the s/sx of parkinsons disease
p. 868- the 4 cardinal symptoms are: tremor, muscle rigidity, bradykinesia (slow movement) or akinesia (no movement), and postural instability
What is ICP and how do you assess for it
p. 936-937 ICP (intracranial pressure)- patient is most at risk for increased ICP resulting from edema within the first 72 hours
s/sx of increased ICP- decreased LOC, restlessness, irritability, confusion, headache, N/V, change in speech pattern, slurred speech, dilated and nonreactive pupils, seizures, cushing's triad (severe HTN, widened pulse pressure, bradycardia)
Define seizure
p. 876- abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in LOC, motor or sensory ability and behavior
S/Sx of myasthenia gravis
p. 917- progressive muscle weakness that worsens with repetitive use and usually improves with rest, poor posture, ocular palsies, ptosis (incomplete eyelid closure), diplopia (double vision), respiratory compromise, loss of bowel and bladder control, fatigue, muscle achiness, paresthesias (pins and needles), decreased sense of smell and taste
Describe clonus
p. 849- is also called myoclonus, is the sudden, brief, jerking contraction of a muscle or muscle group often seen in seizures
What medications are used to manage parkinsons disease
p. 870- dopamine agonists (mirapex, requip), levodopa-carbidopa (sinemet), catechol O-methyltransferases (COMTs)inhibitors such as comtan, monamine oxidase type B (MAO-B) inhibitors
What are non-surgical interventions for a CVA
p. 935- IV fibrinolytic therapy and endovascular interventions
fibrinolytic (clot busting drug)- administer alteplase within 3 hours of stroke onset
endovascular- intra arterial thrombolysis using drug therapy, mechanical embolectomy (clot removal) and carotid stent placement
Name the different types of seizures and characteristics of each
p. 876- generalized seizures
tonic-clonic seizure lasting 2-5 minutes begins with a tonic phrase that causes stiffening or rigidity of the muscles. Clonic or rhythmic jerking of all extremities follows
tonic seizure- abrupt increase in muscle tone and loss of consciousness
clonic seizure- causes muscle contraction and relaxation
myoclonic seizure- causes a brief jerking or stiffening of the extremities
atonic seizure- sudden loss of muscle tone followed by postictal confusion
Partial Seizures- are focal or local begin in a part of one cerebral hemisphere
Complex partial seizure- cause a blackout for 1-3 minutes
Simple partial seizure- remains conscious throughout the episode and often reports an aura
Unclassified or idiopathic seizures- they occur for no known reason and do not fit into the generalized or partial classification
Non-surgical management of MG?
p. 919- providing respiratory support, promote mobility, administer drug therapy, plasmapheresis, noninvasive mechanical ventilation
Describe Romberg sign
p. 850- When one sways with the eyes closed but not when the eyes are open
What surgical interventions manage parkinsons
p. 872- stereotactic pallidotomy- opening into the pallidum within the corpus striatum
deep brain stimulation- electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that delivers electrical current
fetal tissue transplantation- still experimental and highly controversial
List the s/sx of a CVA
p. 932- the five most common symptoms are: sudden confusion or trouble speaking or understanding others; sudden numbness or weakness in the face, arm or leg; sudden trouble seeing in one or both eyes; sudden dizziness, trouble walking, or loss of balance or coordination; sudden severe headache with no known cause
How are seizures diagnosed?
p. 877- diagnosis is based on the history and physical exam. Typical diagnostic tests include an electroencephalogram (EEG), CT scan, MRI, or PET scan.
Surgical management of MG
p. 921- removal of the thymus gland or sternal split procedure
What is the Glasgow Coma Scale
p. 850- standard rapid neurologic assessment tool used to establish baseline data in each of these areas: eye opening, motor response, and verbal response. The patient is assigned a numeric score for each of these areas. The lower the score, the lower the patient's neurologic function. The highest possible score is 15.
What labs and imaging assess for parkinsons disease
p.869-870- there are no specific tests. Analysis of CSF may show a decrease in dopamine levels. Other tests may include an MRI or single-photon emission computed tomography (SPECT) to rule out other CNS health problems
What are the different types of CVA
p. 928- ischemic stroke is caused by the occlusion/blockage of a cerebral or carotid artery by either a thrombus or an embolus. A stroke that is caused by a thrombus (clot) is a thrombotic stroke whereas a stroke caused by an embolus (dislodged clot) is referred to as an embolic stroke
hemorrhagic- vessel integrity is interrupted and bleeding occurs into the brain tissue or into the subarachnoid space
What drug therapy is used to manage a patient having a seizure
p. 877- antiepileptic drugs (anticonvulsants)
Examples: phenytoin, carbamazepine, lamictal, valproic acid, gabapentin, lyrica, keppra, topamax
Name 3 nursing interventions for caring for a patient with myasthenia gravis
p. 919- provide respiratory support (suction PRN, perform chest physiotherapy), promote mobility (assess muscle strength, plan periods of rest, assess for skin breakdown, use pressure reducing devices), administer drug therapy (anticholinesterases and immunosuppressants- give on time to maintain blood levels and thus improve muscle strength)