Part 1: Neuro ANSWERS!!!

(Theory 2)

1. ICP stands for Increased Intracranial Pressure

2. Increased ICP is a rise in the pressure inside the skull that can result from or cause brain injury.
3. Diagnostic Tests:

a. MRI or CT scan of head

b. Spinal tap
4. Treatments:

5. Nursing Interventions:
6. Glasgow Coma Scale Focused on: Eye opening, Verbal Response and Best Motor Response

7. A nurse is observing a new graduate as she performs a Glasgow Coma Scale (GCS). Which of the
following indicates that the new graduate understands the assessment criteria?

a. Voice commands, posturing, reflexes.

b. Posturing, reflexes, eye opening.

c. Eye opening, verbal response, motor response.

d. Seizure activity, motor response, verbal response.

The correct answer is: Eye opening, verbal response, motor response.
The Glasgow Coma Scale (GCS) is used to assess the level of
consciousness and neurological function in patients. It consists of three
components: eye opening, verbal response, and motor response. The
nurse should observe the patient's response to each of these
components and assign a score based on their level of response.
Voice commands, posturing, and reflexes are not components of the
GCS. Posturing and reflexes may provide additional information about
the patient's neurological status, but they are not part of the GCS
assessment.
Seizure activity is also not a component of the GCS. While seizures can
affect a patient's level of consciousness and neurological function, they
require a different type of assessment and management.
 Part 2: Seizure Disorder

1. Seizures are episodes of disturbed brain activity that cause changes in attention or behaviour.

2. Not a disease but a symptom.

3. Causes.

Electrolytes imbalance (sodium or glucose), meningitis, head or brain injury, drug abuse, toxins & fever.

4. PATHOPHYSIOLOGY OF SEIZURE:
6. Diagnostic tests of Seizures:

7. Treatments and nursing process for seizures:

8. Nursing Interventions for Seizures:

9. Quick Check 2!

1. What would you include in your client teaching for a client who is being discharged after a
seizure episode?

When providing client teaching for a client who is being discharged after a seizure
episode, the following information should be included:

1. Medication management: If the patient has been prescribed anti-seizure

medication, it is important to review the medication regimen, including the
dosing schedule and any potential side effects. It is important that the patient
takes their medication as prescribed to help prevent future seizures.
2. Triggers and warning signs: Discuss with the patient the possible triggers that
may cause seizures, such as lack of sleep or stress. Help the patient identify
warning signs of a seizure, such as an aura or a feeling of déjà vu. Encourage the
patient to avoid triggers as much as possible and to seek medical attention if
they experience warning signs.
3. Safety precautions: Review safety precautions with the patient to prevent injury
during a seizure. For example, they should avoid activities such as swimming,
driving or operating heavy machinery until their healthcare provider gives
clearance. They should also consider wearing a medical alert bracelet or necklace
to notify others that they have a history of seizures.
4. Lifestyle modifications: Encourage the patient to adopt a healthy lifestyle,
including regular exercise, a balanced diet, and adequate sleep. Avoiding drugs
and alcohol is also important as they can trigger seizures.
 5. Follow-up appointments: Ensure the patient understands the importance of
attending follow-up appointments with their healthcare provider, and have them
schedule a follow-up appointment before they leave the hospital.
6. Emergency protocol: Provide instructions on what to do in case of a seizure.
Teach family members or caregivers how to position the patient during a seizure,
protect their airway, and what to do if the seizure lasts longer than usual.

By providing comprehensive client teaching, the patient can be empowered to take

control of their health and prevent future seizures.

2. What are some of the “Dos” and “Don’ts” in the management of seizures?

Here are some "Dos" and "Don'ts" in the management of seizures:

Dos:

1. Do call for medical help if a seizure lasts for more than five minutes or if another
seizure occurs soon after the first one.
2. Do stay calm and keep the person safe during the seizure. Remove any nearby
sharp objects, and cushion the person's head with a soft object.
3. Do time the duration of the seizure, and note any unusual behavior, movements,
or sounds made by the person during the seizure.
4. Do turn the person onto their side if they are lying down to prevent choking on
any fluids or vomit.
5. Do provide reassurance to the person after the seizure is over and stay with them
until they are fully alert and oriented.

Don'ts:

1. Don't restrain the person during the seizure or try to force anything into their
mouth.
2. Don't try to move the person unless they are in danger or their position is
obstructing their breathing.
3. Don't try to give the person any food or drink until they are fully alert and can
swallow safely.
4. Don't give the person any medication or treatment unless prescribed by a
healthcare provider.
5. Don't panic or become anxious, as this may worsen the person's anxiety and
confusion. Stay calm and provide a safe environment for them.
PART 2:

1. Any trauma to the scalp, skull or brain. “HEAD INJURY”

2. Head trauma includes an alteration in consciousness no matter how brief.

3. Diagnostic tests:

4. Treatments (2 kinds)
 5. Nursing Interventions (YOU SHOULD KNOW THIS!!!!!)

Quick Check 3!

1. Can head injury clients have increased ICP? YES!!!!

2. What are the strategies to prevent head injury?

Reduce alcohol and drug use

Head injuries can have serious consequences and can be prevented with proper
precautions. Here are some strategies to prevent head injury:

1. Wear protective gear: Wear a helmet when riding a bike or motorcycle, playing
contact sports, or engaging in any activity where head injury is a risk.
2. Use seat belts: Always use seat belts while driving or riding in a car to prevent
head injury in the event of a crash.
3. Childproof your home: Take steps to make your home safe for children, such as
using safety gates, padding sharp corners, and securing heavy furniture to
prevent falls.
4. Avoid high-risk activities: Avoid activities such as extreme sports, which increase
the risk of head injury.
5. Practice safe driving: Follow traffic rules and regulations, drive at safe speeds, and
avoid driving under the influence of drugs or alcohol.
6. Keep the workplace safe: Employers should provide protective gear and
implement safety measures to prevent head injuries in the workplace.
 7. Prevent falls: Falls are a leading cause of head injury, especially in older adults.
Use nonslip mats in the bathroom and install handrails on stairways to prevent
falls.

By following these strategies, you can reduce the risk of head injury and keep yourself
and your loved ones safe.

PART 3: Migraines and Headaches

1. Migraines are painful headaches often accompanied by nausea, vomiting and sensitivity to
light.

2. A migraine episode can be a complicated event, with symptoms that change over hours or
even days.

3. Migraines tend to progress through several stages. (TRUE!!!)

4. Causes of Migraine:

Migraines

 Causes.

 Menstrual migraines or hormone headaches.

 Sleep deficiency.

 Medications.

 Tension and stress.

5. How to prevent it?

Part 4: Parkinson’s Disease

1. Parkinson’s disease is a disorder of the brain that leads to tremors and difficulty with walking,
movement and coordination.

2. Risk Factors.

 After age 50.

  Both men and women.

 Family history.

 Long term use of drugs (phenothiazine).

3. What do you know about Pathophysiology of Parkinsons disease?

4. Manifestation of Parkinson’s Disease:

5. Treatment of Parkinson’s Disease (READ!!!!!!!!!!)

 Part 5: M.S (Multiple Sclerosis)

1. Which disease is this? MULTIPLE SCLEROSIS

2. Risk factors, Manifestations and Diagnostic tests of MS.
3. Nursing interventions of MS:

4. Quick Check 4!

1. What factors can trigger or worsen the multiple sclerosis attacks?

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous
system. MS attacks, also known as relapses or exacerbations, can be triggered or
worsened by various factors, including:

1. Infections: Viral or bacterial infections, such as urinary tract infections, respiratory

infections, or the flu, can trigger an MS attack.
2. Stress: Emotional or physical stress can trigger or worsen an MS attack.
3. Heat: Exposure to high temperatures or hot weather can trigger or worsen MS
symptoms.
4. Fatigue: Fatigue can exacerbate MS symptoms and increase the risk of an attack.
5. Medications: Certain medications, such as beta-interferons, can increase the risk
of an MS attack.
6. Pregnancy: Pregnancy can affect the immune system and increase the risk of an
MS attack.
7. Smoking: Smoking can worsen MS symptoms and increase the risk of an attack.
8. Lack of Vitamin D: A deficiency in vitamin D, which is essential for bone health
and the immune system, has been linked to an increased risk of MS attacks.
9. Lack of exercise: Physical inactivity and a sedentary lifestyle have been associated
with a higher risk of MS attacks.
 10. Alcohol consumption: Excessive alcohol consumption can worsen MS symptoms
and increase the risk of an attack.

It is important for individuals with MS to be aware of these triggers and take steps to
avoid or manage them as much as possible to minimize the risk of attacks.

2. What is the treatment for multiple sclerosis?

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous
system. The treatment for MS aims to reduce the severity of symptoms, slow the
progression of the disease, and improve the patient's quality of life.

Here are some common treatments for MS:

1. Disease-modifying therapies (DMTs): These are drugs that modify the immune
system to reduce inflammation and slow the progression of the disease. There
are several types of DMTs available, including interferons, glatiramer acetate, and
monoclonal antibodies. The choice of DMT depends on the type and severity of
MS.
2. Corticosteroids: Corticosteroids are used to reduce inflammation and decrease
the severity of symptoms during relapses or exacerbations of MS. They are
usually given in high doses for a short period of time.
3. Symptomatic treatments: MS symptoms such as muscle spasms, fatigue, and pain
can be treated with medications, physical therapy, or occupational therapy.
4. Plasma exchange: Plasma exchange, also known as plasmapheresis, is a
procedure in which the plasma is removed from the blood and replaced with a
substitute solution. It can be used to treat severe relapses of MS.
5. Stem cell transplantation: Stem cell transplantation is a new and experimental
treatment for MS. It involves using chemotherapy to destroy the immune system
and then transplanting stem cells to rebuild it. The goal is to "reset" the immune
system and stop the progression of the disease.

It's important to note that the treatment plan for MS is highly individualized, and what
works for one person may not work for another. It's important to work closely with a
healthcare provider to develop a treatment plan that is tailored to your needs.

3. What type of drugs are used during acute exacerbations?

4. Corticosteroids are the drugs commonly used during acute exacerbations of

multiple sclerosis (MS). Corticosteroids are powerful anti-inflammatory drugs that
 can help to reduce inflammation in the central nervous system, which is a key
factor in MS exacerbations.
5. The most commonly used corticosteroids for MS exacerbations are intravenous
methylprednisolone and oral prednisone. Intravenous methylprednisolone is
usually given as a high dose for 3-5 days, while oral prednisone is usually given as
a tapering dose over several weeks.
6. These drugs can help to reduce the severity and duration of MS exacerbations,
and can also help to speed up recovery. However, they are not a cure for MS and
do not prevent future exacerbations.
7. It's important to note that corticosteroids can have side effects, such as mood
changes, weight gain, and increased blood pressure, so they should only be used
under the guidance of a healthcare provider. Other symptomatic treatments, such
as muscle relaxants or pain relievers, may also be used during MS exacerbations,
depending on the symptoms and their severity.

PART 6: (stroke)

1. Decreased blood supply to a part of the brain. STROKE

Also known as CVA or sometimes called as “brain attack”.

2. In STROKE, Onset may be sudden or gradual.

3. Left CVA results in right-sided involvement—speech problems. TRUE

4. Right CVA results in left-sided involvement—safety and judgment problems. TRUE

5. What are 2 types of Strokes?

6. Define FAST?
7. Etiology, causes of Stroke:

8. Clinical Manifestations (Subjective and Objective Data for Stroke Patients)

9. DIAGNOSTIC TESTS FOR PATIENTS W/ STROKE

10. Treatments for Stroke Patients

 11. REHABILITATION is good for the stroke patients. YES

12. Think and Pair Share:

13. Devices for stroke patients:

Quick Check 5!

1. What are the early signs of stroke?

The early signs of stroke can vary depending on the type of stroke and the area of the
brain that is affected. However, the most common signs and symptoms of stroke
include:

1. Sudden numbness or weakness in the face, arm or leg, especially on one side of
the body
2. Confusion, trouble speaking or understanding speech
3. Difficulty seeing in one or both eyes
4. Severe headache with no known cause
5. Trouble walking, dizziness, loss of balance or coordination

It's important to note that these signs and symptoms can appear suddenly and without
warning. If you or someone you know is experiencing any of these symptoms, it's
important to seek medical attention immediately. Remember that "time is brain" - the
faster the stroke is diagnosed and treated, the better the chances of recovery.
 2. How can a nurse educate a client to prevent stroke?

As a nurse, there are several ways you can educate a client to prevent stroke. Here are
some tips:

1. Encourage healthy lifestyle habits: Advise the client to maintain a healthy weight,
eat a healthy diet, exercise regularly, quit smoking, and limit alcohol intake. These
lifestyle changes can significantly reduce the risk of stroke.
2. Monitor blood pressure: High blood pressure is a major risk factor for stroke.
Encourage the client to monitor their blood pressure regularly and take any
prescribed medications as directed.
3. Manage diabetes: High blood sugar levels can damage blood vessels and
increase the risk of stroke. Encourage the client to manage their diabetes through
medication, diet, and exercise.
4. Manage cholesterol: High levels of LDL ("bad") cholesterol can increase the risk of
stroke. Encourage the client to manage their cholesterol levels through diet and
exercise, and take any prescribed medications as directed.
5. Recognize the signs of stroke: Educate the client on the signs and symptoms of
stroke, as well as the importance of seeking immediate medical attention if they
or someone they know experiences these symptoms.
6. Take medications as directed: If the client has been prescribed medications to
prevent stroke, such as aspirin or blood thinners, encourage them to take these
medications as directed by their healthcare provider.
7. Schedule regular check-ups: Encourage the client to schedule regular check-ups
with their healthcare provider to monitor their overall health and identify any risk
factors for stroke.

By educating clients on these preventive measures, nurses can help reduce the risk of
stroke and improve overall health outcomes.
Case Study
Neurological Conditions: Stroke

Chief Complaint: Mr. Bill Watson, a 78-year-old man was admitted with weakness on the right side and
slurred speech.

History: Mr. Bill Watson, 78-year-old man, was admitted with weakness on the right side and slurred
speech. He is a retired construction worker; his hobbies are carpentry and watching television. He is
divorced. An adult daughter and her two teenagers live with him. His daughter assisted with the history as
the client had some difficulty responding verbally.

Subjective Data:
• Had type 2 DM for 10 years and is treated with an oral hypoglycemic agent.
• He is obese and had a MI at age 75.
• Has no recent changes in vision but does wear reading glasses.
• Has good hearing and no headaches.
• He is right handed.
• Unable to stand when he awoke this morning.
• Tried to drink some water but had difficulty swallowing.
• Has had no loss of bowel or bladder control.

Objective Data:
• Vital signs: B/P 210/104, PR 96, RR 22, Temp 36°C.
• Acknowledges he is in hospital but is uncertain about day, date and time.
• Uses gestures to respond to some questions when he seems unable to find the right word.

Critical Thinking Questions

1. What effect might this client’s stroke have on his daughter and family?

This client's stroke could have a significant effect on his daughter and family, as he may
require significant assistance with activities of daily living and rehabilitation following the
stroke. They may need to provide emotional support and help with physical care and
rehabilitation exercises, which can be a significant burden for caregivers. The client's
daughter may need to take time off work to care for her father, which could impact the
family's finances. There may also be changes to the family dynamic, as the client's ability
to participate in activities may be limited, and he may need to rely on his family
members for transportation and other forms of support. Additionally, the family may
need to make modifications to the home to make it more accessible and safe for the
client's recovery. All of these changes can be stressful and challenging for the family
members, and they may need support and resources to help them cope with the
situation.

2. Describe three examples of signs of anxiety that the client exhibits?

From the subjective and objective data provided, there is no direct mention of the client
exhibiting signs of anxiety. However, anxiety is a common emotional response that can
occur following a stroke, and clients may exhibit signs such as:
 1. Restlessness and agitation: The client may appear restless, fidgety, and have
difficulty staying still or calming down.
2. Excessive worry or fear: The client may express excessive worry or fear about their
health, recovery, or future, which can interfere with their ability to participate in
rehabilitation activities.
3. Panic attacks: The client may experience sudden and intense feelings of fear or
panic, which can cause symptoms such as rapid heart rate, shortness of breath,
and sweating.

It's important to note that these signs may also be caused by other factors, and a
healthcare professional should evaluate the client's symptoms to determine the cause
and appropriate treatment.

3. What data in this assessment are consistent with stroke?

Several pieces of data in this assessment are consistent with stroke, including:

1. Weakness on the right side: The weakness on the right side of the body is a
common sign of stroke, as strokes often affect one side of the brain, which can
cause weakness or paralysis on the opposite side of the body.
2. Slurred speech: Speech difficulties, such as slurred speech or difficulty finding the
right words, are also common signs of stroke.
3. Hypertension: The elevated blood pressure (210/104) can be a risk factor for
stroke.
4. Difficulty swallowing: Difficulty swallowing, also known as dysphagia, is a
common complication of stroke.
5. Confusion: The client's confusion about the day, date, and time is also consistent
with stroke, as strokes can affect cognitive function and cause confusion or
memory problems.

Overall, the combination of weakness on the right side, slurred speech, hypertension,
difficulty swallowing, and confusion are consistent with a diagnosis of stroke. However,
additional tests and assessments, such as a CT scan or MRI, may be needed to confirm
the diagnosis and determine the extent and location of the stroke.

4. Identify three nursing diagnosis and appropriate interventions for Mr. Watson.

Three nursing diagnosis for Mr. Watson based on his chief complaint, history and
objective data are:
 1. Impaired verbal communication related to slurred speech and difficulty finding
the right words as evidenced by the use of gestures to respond to questions.

Interventions:

 Encourage the client to communicate as much as possible, use non-verbal cues if

necessary.
 Use a communication board or a picture chart to assist with communication.
 Speak slowly and clearly, allowing the client time to respond.
 Consult with a speech therapist for evaluation and intervention.
2. Risk for falls related to weakness on the right side and inability to stand as
evidenced by the client's report.

Interventions:

 Assess the client's mobility and balance frequently.

 Use bed rails and assistive devices as appropriate.
 Ensure that the environment is free from hazards.
 Encourage the client to call for assistance when needed.
3. Impaired swallowing related to difficulty swallowing as evidenced by the client's
report.

Interventions:

 Refer the client to a speech therapist for a swallow evaluation.

 Provide thickened liquids or pureed foods as ordered.
 Sit the client upright and ensure that he is positioned properly during meals.
 Monitor the client for signs of aspiration or choking.

Note: It is important to consult with the healthcare provider for appropriate

interventions based on the client's individual needs and medical condition.

PRACTICE THIS FOR NURS153!!!!

Happy studying!!!! <3

Love,

Coleen :P