CHAPTER 59 Chronic Neurologic Problems
Nervous System
CASE STUDY
Epilepsy With Headache
Patient Profile
J.P. is a 24-yr-old woman who was diagnosed with
epilepsy at age 15. At that time, she had a tonic-clonic
seizure and was given a prescription for phenytoin
(Dilantin). She had a second witnessed seizure 4 mo
later, but has since been seizure free. J.P. now has
complaints of headaches and says she is afraid that
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her seizures are going to return. She is single, lives
alone, and describes her job as stressful.
Subjective Data
• Describes headache pain on the left side of her forehead as throbbing
• Has vomited with headache
• Describes changes in vision, including flashing lights
• Headache occurs nearly every month on a regular cycle
Objective Data
• Alert and oriented to person
• Neurologic examination negative
Answers available at http://evolve.elsevier.com/Lewis/medsurg.
BRIDGE TO NCLEX EXAMINATION
The number of the question corresponds to the same-numbered
outcome at the beginning of the chapter.
1. A 50-year-old man complains of recurring headaches. He describes
these as sharp, stabbing, and located around his left eye. He also
reports that his left eye seems to swell and get teary when these
headaches occur. Based on this history, you suspect that he has
a. cluster headaches.
b. tension headaches.
c. migraine headaches.
d. medication overuse headaches.
2. A 65-year-old woman was just diagnosed with Parkinson’s disease.
The priority nursing intervention is
a. searching the Internet for educational videos.
b. evaluating the home for environmental safety.
c. promoting physical exercise and a well-balanced diet.
d. designing an exercise program to strengthen and stretch specific
muscles.
3. The nurse finds that an 87-year-old woman with Alzheimer’s
disease is continually rubbing, flexing, and kicking out her legs
throughout the day. The night shift reports that this same behavior
escalates at night, preventing her from obtaining her required sleep.
The next step the nurse should take is to
a. ask the physician for a daytime sedative for the patient.
b. request soft restraints to prevent her from falling out of her bed.
c. ask the physician for a nighttime sleep medication for the
patient.
d. assess the patient more closely, suspecting a disorder such as
restless legs syndrome.
REFERENCES
*1. Mathew PG, Garza I: Headache, Semin Neurol 31:5, 2011.
*2. Lipton RB: Chronic migraine, classification, differential
diagnosis, and epidemiology, Headache 51:77, 2011.
*Evidence-based information for clinical practice.
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• Phenytoin level within normal limits
• EEG normal
• CT of head normal
Discussion Questions
1. What is epilepsy?
2. What is the pathophysiology of epilepsy?
3. What is the significance of the laboratory and diagnostic findings?
4. Is the headache related to seizure activity?
5. Priority Decision: What is a priority nursing intervention for J.P.?
6. What should be included in the teaching plan for J.P. regarding the
course of the disease?
7. Priority Decision: Based on the assessment data, what are the priority
nursing diagnoses?
8. Evidence-Based Practice: Based on current treatment guidelines,
what medication may be effective in managing both J.P.’s epilepsy and
her migraine headaches?
4. Social effects of a chronic neurologic disease include (select all that
apply)
a. divorce.
b. job loss.
c. depression.
d. role changes.
e. loss of self-esteem.
5. The nurse is reinforcing teaching with a newly diagnosed patient
with amyotrophic lateral sclerosis. Which statement would be
appropriate to include in the teaching?
a. “ALS results from an excess chemical in the brain, and the symp-
toms can be controlled with medication.”
b. “Even though the symptoms you are experiencing are severe,
most people recover with treatment.”
c. “You need to consider advance directives now, since you will lose
cognitive function as the disease progresses.”
d. “This is a progressing disease that eventually results in perma-
nent paralysis, though you will not lose any cognitive function.”
1. a, 2. c, 3. d, 4. a, b, c, d, e, 5. d
For rationales to these answers and even more NCLEX review ques-
tions, visit http://evolve.elsevier.com/Lewis/medsurg.
3. Goldman L, Schafer AI: Goldman’s Cecil medicine, ed 24,
St Louis, 2012, Mosby.
*4. Rozen TD, Fishman RS: Cluster headache in the United States
of America, Headache 52:99, 2012.
*5. Rothrock JF: Onabotulinumtoxin A for the treatment of
chronic migraine, Headache 51:659, 2011.
*6. Halker R, Vargas B, Dodick DW: Cluster headache: diagnosis
and treatment, Semin Neurol 30:175, 2010.