B
Full recovery is expected from viral meningitis, and any residual effects are rare and minor compared with those of bacterial meningitis. The bacterial form can cause dementia, seizures, deafness, hemiplegia, and hydrocephalus. Viral meningitis is managed symptomatically because the disease is self-limiting, a full recovery is expected, and there usually is no brain involvement. Antibiotics are not used for viruses. Both forms manifest with the symptoms of headache, fever, photophobia, and stiff neck. D
Nonmodifiable risk factors for stroke include age (>65 years), male gender, ethnicity or race (African Americans > Hispanics, Native Americans/Alaska Natives, and Asian Americans > whites), and family history of stroke or personal history of a transient ischemic attack or stroke. Modifiable risk factors for stroke include hypertension (most important), heart disease (especially atrial fibrillation), smoking, excessive alcohol consumption (causes hypertension), abdominal obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet (high in saturated fat and low in fruits and vegetables), and drug abuse (especially cocaine). Other risk factors for stroke include a diagnosis of diabetes mellitus, increased serum cholesterol, birth control pills (high levels of progestin and estrogen), history of migraine headaches, inflammatory conditions, hyperhomocysteinemia, and sickle cell disease. A,D,E
The patient with a stroke may experience many losses, including sensory, intellectual, communicative, functional, role behavior, emotional, social, and vocational losses. Some patients experience long-term depression and symptoms such as anxiety, weight loss, fatigue, poor appetite, and sleep disturbances. The time and energy required to perform previously simple tasks can result in anger and frustration. Frustration and depression are common in the first year after a stroke. A stroke is usually a sudden, extremely stressful event for the patient, caregiver, family, and significant others. The family is often affected emotionally, socially, and financially, as well as changing roles and responsibilities. Reactions vary considerably but may involve fear, apprehension, denial of the severity of the stroke, depression, anger, and sorrow. A,B,C,D
Identify high-risk patients, including those with neurologic disorders, sensory impairment, or advanced age. Other risk factors include hospitalization in an intensive care unit, lack of a watch or calendar, absence of reading glasses, and untreated pain. Precipitating factors are eliminated. Assess for drug and alcohol withdrawal, fluid and electrolyte imbalance, nutritional deficiencies, and infection. Care includes protecting from harm, increasing familiarity with the environment, and reorientation and behavioral interventions. Polypharmacy is a common cause; drugs are not used prophylactically for this problem. A
Cluster headaches involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission. The pain of cluster headache is sharp and stabbing; the intense pain lasts from a few minutes to 3 hours. Headaches can occur every other day and as often as 8 times a day. The clusters occur with regularity, usually occurring at the same time each day, during the same seasons of the year. Typically a cluster lasts 2 weeks to 3 months, and then the patient goes into remission for months to years. The pain is generally located around the eye, radiating to the temple, forehead, cheek, nose, or gums. Other manifestations may include swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.
Reference: 1487-1488 You know that dietary teaching has been effective when the patient with multiple sclerosis makes which meal choice?
A. Hamburger, fries, vanilla shake
B. Steak, scalloped potatoes, French toast, iced tea
C. Ham sandwich, potato chips, glass of whole milk
D. Salad with tomatoes, chicken, bran muffin, strawberries, low- fat milk D
The severity of restless legs syndrome (RLS) sensory symptoms ranges from infrequent minor discomfort (paresthesias, including numbness, tingling, and "pins and needles" sensation) to severe pain. The discomfort occurs when the patient is sedentary and is most common in the evening or at night. The pain at night can produce sleep disruptions and is often relieved by physical activity such as walking, stretching, rocking, or kicking. In the most severe cases, patients sleep only a few hours at night, resulting in daytime fatigue and disruption of the daily routine. The motor abnormalities associated with RLS consist of voluntary restlessness and stereotyped, periodic, involuntary movements. The involuntary movements usually occur during sleep. Symptoms are aggravated by fatigue.
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