Study sets, textbooks, questions
Upgrade to remove ads
Ch. 66 - Management of Patients with a Neurologic Dysfunction
Terms in this set (55)
Episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) that result from sudden excessive discharge from cerebral neurons
occur in and rapidly engage bilaterally distributed networks of the brain.
thought to originate within one hemisphere in the brain.
termed because of incomplete data but are not considered a classification
Causes of seizures include:
• Cerebrovascular disease.
• Hypoxemia of any cause, including vascular insufficiency.
• Fever (childhood).
• Head injury.
• CNS infections.
• Metabolic and toxic conditions (e.g., renal failure, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure).
• Brain tumor.
• Drug and alcohol withdrawal.
Seizure Clinical Manifestations
Only a finger or hand may shake, or the mouth may jerk uncontrollably. The person may talk unintelligibly; may be dizzy; and may experience unusual or unpleasant sights, sounds, odors, or tastes, but without loss of consciousness
Generalized Seizure Clinical Manifestations
Often involve both hemispheres of the brain, causing both sides of the body to react.
Intense rigidity of the entire body,alternating muscle relaxation and contraction (generalized tonic-clonic contraction). Contractions of the diaphragm and chest muscles may produce a characteristic epileptic cry. The tongue is often chewed, and the patient is incontinent of urine and feces. After 1 or 2 minutes, the convulsive movements begin to subside; the patient relaxes and lies in deep coma, breathing noisily. The respirations at this point are chiefly abdominal. In the postictal state (after the seizure), the patient is often confused and hard to arouse and may sleep for hours. Many patients report headache, sore muscles, fatigue, and depression
Focal Seizure Clinical Manifestations
Have no natural classification. There may be an impairment of consciousness or awareness or other dyscognitive features, localization, and progression of ictal events
Nurse Management DURING a seizure
SAFETY, do not move the patient, If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions.
Nurse Management AFTER a seizure
To prevent complications, the patient is placed in the side-lying position to facilitate drainage of oral secretions, and suctioning is performed, if needed, to maintain a patent airway and prevent aspiration.
is a group of syndromes characterized by unprovoked, recurring seizures
Idiopathic (unknown cause)
when the cause is known and the epilepsy is a symptom of another underlying condition, such as a brain tumor
Epilepsy Risk Factors
The improved treatment for cerebrovascular disorders, head injuries, brain tumors, meningitis, and encephalitis; after recovery from these conditions
Epilepsy in Women
*Increase in seizure frequency during menses.
*Linked to the increase in sex hormones that alter the excitability of neurons in the cerebral cortex.
*The effectiveness of contraceptives is decreased by antiseizure medications.
*The risk of congenital fetal anomaly is two to three times higher in women with epilepsy.
Head injury is one of the main causes of epilepsy that can be prevented.
Epilepsy Medical Management
Management differs from patient to patient, because some forms of epilepsy arise from brain damage and others result from altered brain chemistry.
Is a series of generalized seizures that occur without full recovery of consciousness between attacks.
It is considered a medical emergency.
Factors that precipitate status epilepticus include
withdrawal of antiseizure medication, fever, concurrent infection, or other illness.
Status Epilepticus Medical Management
*IV diazepam (Valium), lorazepam (Ativan), or fosphenytoin is administered slowly in an attempt to halt seizures immediately.
*Or cephalalgia, is one of the most common of all human physical complaints.
*Is a symptom rather than a disease.
Headache may indicate
organic disease (neurologic or other disease), a stress response, vasodilation (migraine), skeletal muscle tension (tension headache), or a combination of factors.
No organic cause can be identified.
This type of headache includes migraine, tension-type, and cluster headaches.
Is another common cause of headache.
Is a cause of headache in the older population, reaching its greatest incidence in those older than 70 years of age. Inflammation of the cranial arteries is characterized by a severe headache localized in the region of the temporal arteries. The inflammation may be generalized (in which case cranial arteritis is part of a vascular disease) or focal (in which case only the cranial arteries are involved).
A symptom associated with another organic cause, such as a brain tumor or an aneurysm.
Migraine Prodrome phase
*Symptoms that occur hours to days before a migraine headache.
*Symptoms may include depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea, or constipation.
*Patients usually experience the same prodrome with each migraine headache.
Migraine Aura phase
*The aura usually lasts less than 1 hour and may provide enough time for the patient to take the prescribed medication to avert an attack.
*This period is characterized by focal neurologic symptoms.
*Visual disturbances are most common.
*Other symptoms that may follow include numbness and tingling of the lips, face, or hands; mild confusion; slight weakness of an extremity; drowsiness; and dizziness.
Migraine Headache phase
*As a decline in serotonin levels occur, a throbbing headache (unilateral in 60% of patients) intensifies over several hours.
*This headache is severe and incapacitating and is often associated with photophobia (light and/or sound sensitivity), nausea, and vomiting; irritability; and fatigue.
*Lasts 4 to 72 hours.
Migraine Recovery phase
* the pain gradually subsides and can last up to 25 hours.
*Muscle contraction in the neck and scalp is common, with associated muscle ache and localized tenderness, exhaustion, and mood changes.
Any physical exertion exacerbates the headache pain.
During this postheadache phase, patients may sleep for extended periods.
characterized by a steady, constant feeling of pressure that usually begins in the forehead, temple, or back of the neck. It is often bandlike or may be described as "a weight on top of my head."
*Are unilateral and come in clusters of one to eight daily, with excruciating pain localized to the eye and orbit and radiating to the facial and temporal regions.
*The pain is accompanied by watering of the eye and nasal congestion.
*Each attack lasts 15 minutes to 3 hours and may have a crescendo-decrescendo pattern.
*The headache is often described as penetrating.
Cranial arteritis Clinical Manifestations
Inflammation (heat, redness, swelling, tenderness, or pain over the involved artery) usually are present.
Sometimes a tender, swollen, or nodular temporal artery is visible.
*Visual problems are caused by ischemia of the involved structures.
Migraine Headache prevention
Cerebral edema peaks at which timeframe post intracranial surgery?
Migraine familial tendency
a strong familial tendency
The initial sign of increasing ICP includes
removes the blood, filters out the antibodies that trigger the autoimmune disease, and then returns the blood to the client.
Indication for papilledema
Swelling of the head of the optic nerve, a sign of increased intracranial pressure.
Which interventions are appropriate for a patient with increased ICP?
• Administering prescribed antipyretics.
• Maintaining aseptic technique with the intraventricular catheter.
• Frequent oral care.
Which nursing intervention reduces the client's risk of increased intracranial pressure (ICP)?
Administering a stool softener
A female patient is receiving hypothermic treatment for uncontrolled fevers related to increased intracranial pressure (ICP). Which of the following assessment finding requires immediate intervention?
Shivering increases ICP
If the brain herniates, which of the following are potential consequences?
• Permanent neurologic dysfunction
• Impaired cellular activity
formerly referred to as petit mal seizures, are more common in children. They are characterized by a brief loss of consciousness, during which physical activity ceases. The person stares blankly; the eyelids flutter; the lips move; and slight movement of the head, arms, and legs occurs. These seizures typically last for a few seconds, and the person seldom falls to the ground. Because of their brief duration and relative lack of prominent movements, these seizures often go unnoticed. People with absence seizures can have them many times a day.
To meet the sensory needs of a client with viral meningitis, which of the following should the nurse do?
Minimize exposure to bright lights and noise.
refers to the shifting of brain tissue form an area of high pressure to an area of lower pressure.
an ability of cerebral blood vessels to dilate or constrict to maintain stable cerebral blood flow despite changes in systemic arterial blood pressure.
is the brain's attempt to restore blood flow by increasing arterial pressure to overcome the increased ICP.
a theory that states that due to limited space for expansion within the skull, an increase in any one of the cranial contents causes a change in the volume of the others.
The most important consideration in managing the patient with altered LOC is to?
establish an adequate airway and ensure ventilation.
An osmotic diuretic, such as mannitol, is given to the patient with increased intracranial pressure (IICP) for which of the following therapeutic effects?
To dehydrate the brain and reduce cerebral edema
After a transsphenoidal hypophysectomy, the client must refrain from?
coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound.
is the flexion and internal rotation of forearms and hands.
is extension and external rotation.
is the absence of motor response
Sets found in the same folder
Chapter 65: Assessment of Neurologic Fun…
Chapter 66: Management of Patients with…
Adult Nursing III, Chapter 66 "Management of Patie…
Chapter 67 Management of Patients with Cerebrovasc…
Sets with similar terms
Chapter 15 - Neurological Emergencies
Adult Nursing III, Chapter 66 "Management of Patie…
Other sets by this creator
Openstax Biology Chapter 5
Property and Casualty Insurance Exam
property and casualty insurance
Property and Casualty Insurance Exam