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Neurological 4

  1. Encephalitis
  2. Definition
    1. acute inflammatory viral disease
    2. can occur as epidemics or sporadically
    3. death rate ranges up to 70%
    4. most common pathogen for sporadic encephalitis is herpes simplex
    5. may follow a systemic viral illness such as chicken pox
  3. Findings
    1. sudden fever
    2. headache
    3. seizures
    4. stiff neck
    5. altered LOC progressing to coma
  4. Diagnostics
    1. history and physical exam
    2. computerized tomogram (CT) scan
    3. brain biopsy
  5. Management
    1. uncomplicated cases require supportive and preventive care
    2. bed or chair rest
    3. maintain nutrition
    4. maintain fluid balance
    5. herpes simplex calls for antivirals: vidarabine (viraA), acyclovir (zoviraz) (illustration)
    6. prevention of increased ICP
  6. Nursing interventions
    1. comfort measures for fever
    2. administer drugs as ordered
    3. seizure precautions 
    4. care of the client with increased ICP 
    5. when needed, ensure isolation and airborne-droplet precautions
  7. Autoimmune Disorders of Neurologic System
  8. Multiple sclerosis
    1. Definition
      1. demyelination of white matter throughout brain and spinal cord (illustration)
      2. third most common cause of disability in clients aged 15 to 60
      3. specific cause unknown
      4. increased incidence in temperate to cool climates
      5. illness improves and worsens unpredictably
    2. Findings depend on the location of the demyelination
      1. cranial nerve: blurred vision, dysphagia, diplopia, facial weakness and/or numbness
      2. motor: weakness, paralysis, spasticity, gait disturbances
      3. sensory: paresthesias, decreased proprioception
      4. cerebellar: dysarthria, tremor, incoordination, ataxia, vertigo
      5. cognitive: decreased short-term memory, difficulty with new information, word-finding difficulty, short attention span
      6. urinary retention or incontinence
      7. loss of bowel control
      8. sexual dysfunction
      9. fatigue
    1. Diagnostics
      1. history and physical exam
      2. lumbar puncture
      3. magnetic resonance imagery (MRI)
      4. computerized tomogram (CT) scan
      5. evoked potentials or response - the EEG record of electrical activity at one of several levels in the CNS by stimulation of an area of the sensory nerve system
    2. Management
      1. expected outcomes: to alleviate findings and prevent complications
      2. pharmacologic: adrenocorticotropic hormone (ACTH)
      3. therapies based on findings
        1. physical
        2. occupational
        3. pharmacologic
    3. Nursing interventions
      1. maintain functional independence in ADL
      2. determine effectiveness of administed medications
      3. prevent complications of immobility
      4. prevent injury from difficulties walking
      5. provide emotional support
      6. provide counseling for sexual dysfunction
      7. teach client to:
        1. avoid fatigue and stress
        2. conserve energy
        3. exercise regularly
        4. know drugs and side effects
        5. use self-help devices
        6. maintain a diet that supports nutrition and energy needs
  9. Guillain-Barre syndrome
    1. Definition
      1. acquired inflammatory disease
      2. process: demyelinization of peripheral nerves
      3. precipitating factors include prior bacterial or viral infection within one to two weeks
    2. Findings
      1. muscle weakness: progressive, ascending, bilateral
      2. leads to paralysis of voluntary muscles
      3. loss of superficial and deep tendon reflexes
      4. bulbarweakness
      5. dysphagia
      6. dysarthria
      7. respiratory failure
      8. sensory findings: paresthesias, burning pain
      9. paralysis may vary from being total to partial of only one-half way up the body
    1. Diagnostics
      1. history and physical exam
      2. lumbar puncture will show increased protein in CSF (illustration)
      3. electromyography (EMG)
    2. Management
      1. expected outcomes: to prevent complications and maintain body functions until any reversal
      2. steroids in acute phase
      3. care as dictated by areas involved
    3. Nursing interventions
      1. maintain the care of client on ventilatory support 
      2. provide for care of the immobilized client
      3. have a safe environment to minimize infection
      4. maintain nutrition and fluid balance
      5. refer families or client to support groups
      6. supply referrals to therapies such as speech, physical, occupational and counseling
  10. Myasthenia gravis
    1. Definition:
      1. antibodies destroy acetylcholine receptors where nerves join muscles (illustration)
      2. two age clusters: women in early adulthood and men in late adulthood
      3. progressive with occurances of crises
    2. Findings
      1. progressive fatigue of voluntary muscles, but no muscular atrophy
      2. facial
        1. ptosis (drooping eyelid) and reduced eye closure
        2. weak smile
        3. diplopia, blurred vision
        4. speech and swallowing disorders
        5. weakness of facial muscles
      3. signs of restrictive lung disease
      4. sensation remains intact
    3. Diagnostics
      1. history and physical exam
      2. edrophonium (tensilon) test: improved muscle strength after tensilon injection indicates a positive test for MG