Chapter 47 Neurologic System Function, Assessment, and Therapeutic Measures

Answers CHAPTER 47 NEUROLOGIC SYSTEM FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Mrs. Beason Passes Out 1. Level of consciousness and orientation, vital signs, pupil responses, bilateral strength in extremities, and sensation. 2. Asking where she is can determine orientation to place. Disorientation can signal many neurological and non-neurological disorders. 3. Explain that an angiogram uses injected dye to view blood vessels. Include the following: a. Administer clear liquids prior to the procedure. b. Explain that dye will be injected into an artery in the groin. c. Explain that dye may cause flushing and a feeling of warmth in the groin that can feel like she has wet her pants. d. Advise that she will need to lie flat after the test to prevent bleeding. e. Advise that she will need to drink fluids to flush dye from her system following the test. f. Explain that her nurse will do frequent checks following the procedure. 4. An angiogram can be used to check the carotid arteries for occlusion, which can increase risk of stroke. Mrs. Beason may have been having warning signs of an impending stroke. VOCABULARY 1. dysphagia 2. electroencephalogram 3. paresthesia 4. decorticate 5. decerebrate 6. Anisocoria 7. nystagmus 8. contractures 9. dysarthria 10. aphasia DIAGNOSTIC TESTS 1. A myelogram is an x-ray (or computed tomography [CT] scan or magnetic resonance imaging [MRI]) examination of the spinal canal after injection of contrast material into the subarachnoid space. Before the procedure, ask the patient about allergies to contrast media. Make sure that a consent form has been signed. Check institution policy for NPO (nothing by mouth) guidelines. Following the procedure, the patient is maintained on bedrest, positioned with the head elevated or according to health care provider’s (HCP’s) orders (based on type of contrast medium used). Fluids are encouraged to help the kidneys excrete the contrast medium. 2. An electroencephalogram (EEG) uses electrodes attached to the scalp to monitor the electrical activity of the brain. Before the procedure, make sure the patient’s hair is clean and dry. Check with the HCP for any medications to hold. After the procedure, monitor for seizures, especially if seizure medications were held. Wash the adhesive from the hair as soon as possible before it becomes hard and difficult to remove. 1 2 Chapter 47 Answers 3. A lumbar puncture involves a needle into the spinal fluid to collect cerebrospinal fluid (CSF) for analysis. Before the procedure, you may ask the HCP for an order for an analgesic or sedative if the patient is especially anxious. Make sure that a consent form has been signed. Assist the patient into a side-lying position with knees flexed and back arched. Some HCPs prefer the patient sitting on the edge of the bed leaning over a bedside table. Stay with the patient to offer reassurance and assist the HCP with specimens. Following the procedure, check orders for bedrest and encourage fluids. Monitor the puncture site for leakage of CSF. Notify the HCP if a headache occurs. 4. MRI uses magnetic energy to produce images of tissues. It is not an x-ray. Ask patients if they have any metal in their bodies (e.g., pacemakers, joint replacements, foreign bodies, metal-based tattoos); if so, they may not be able to have an MRI. Instruct the patient that he or she will be in a tunnel-like machine for 30 to 60 minutes and that there will be banging noises. If the patient is claustrophobic, notify the HCP and obtain a sedative or alternative order. If the patient is in pain, request analgesic orders for use before the procedure. No special aftercare is necessary. 5. A CT scan produces images of layers (“slices”) of tissue. It usually requires that the body or body part be within the scanner, which may be difficult for claustrophobic people. The HCP may order contrast material. Find out if this is planned, and ensure the patient has no allergies to contrast material. The HCP should be notified if kidney function is compromised because kidneys excrete the dye. Check institution policy to determine whether the patient should be kept NPO before the procedure. If dye is used, the patient should be prepared to expect a feeling of warmth during the injection. Following any procedure using dye, fluids should be encouraged. If dye is not used, no special aftercare is necessary. ANATOMY Central sulcus Precentral gyrus Postcentral gyrus Parietal lobe Frontal lobe Occipital lobe Lateral sulcus Temporal lobe Chapter 47 Answers Nucleus Cell body or Soma Dendrites Axon Myelin sheath Nodes of Ranvier Synaptic knobs ANATOMY REVIEW ASSESSMENT OF CRANIAL NERVES 1. (5) 2. (4) 3. (1) 4. (3) 5. (2) 1. (3) 2. (4) 3. (2) 4. (1) 5. (5) 3 4 Chapter 47 Answers CRITICAL THINKING 1. After checking her transfer records for previous activity level, check muscle strength in her legs and feet. Ask how she got up to go to the bathroom at the hospital. Then have a second nurse or aide help in dangling her at the bedside and slowly standing before attempting to ambulate. If she is unable to dangle or stand, use a bedpan or bedside commode until she can be evaluated by the physical therapy department. Document how she did and how much assistance she needed in the plan of care. Consider whether she needs an order for physical or occupational therapy. 2. Again, check her transfer records, and ask how she ate at the hospital, keeping in mind that her answers may not be reliable. Check for a gag reflex. Make sure she is sitting straight up to eat, preferably in a chair. Try small sips and bites first. Stay with her for the first meal to monitor her swallowing. Because she is weak on one side, check her mouth after each bite for pocketing of food. 3. Ask questions to determine her orientation, such as the month and year; where she is; and who familiar visitors are. Check recent and remote memory (“What did you have for lunch?” “What is your mother’s name?”) Clarify her question; she may have a perfectly legitimate reason to ask for the cookies. 4. Blood pressure is affected by muscle tone. A weak arm may have a lower pressure. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. (1, 3, 4) are incorrect. 2. (2) is correct. (1) is incorrect. 3. (1) is correct. (2, 3, 4) are incorrect. 4. (2) is correct. (1, 3, 4) are incorrect. 5. (4) is correct. (1, 2, 3) are incorrect. 6. (1) is correct. (2, 3, 4) are incorrect. 7. (3) is correct. (1, 2, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 8. (2, 4) are correct. The cervical nerves supply the back of the head, the neck, the shoulders and arms, and the diaphragm and thus would be responsible for writing (arm movement) and nodding (head movement). Cranial nerves (facial nerve) are responsible for the contraction of facial muscles and (hypoglossal) the movement of the tongue. The first and second thoracic nerves also contribute to peripheral nerves in the arms. Other thoracic nerves supply the trunk of the body. Lumbar and sacral nerves supply the hips, pelvic cavity, and legs. 9. (3) is correct. The patient is positioned on the side (or sitting) to expose the spinal column for puncture. (1, 2, 4) are not necessary for a lumbar puncture . 10. (1) is correct. High-top tennis shoes will maintain foot alignment and help prevent foot drop. (2) is incorrect. Muscle relaxants won’t promote walking. (3) is incorrect. It is important to reduce pressure on bony prominences, but it will not promote walking. (4) is incorrect. Ability to manage personal care independently will not promote walking. 11. (4) is correct. Metal of any kind can be attracted to the powerful magnets in a magnetic resonance imaging machine. (1) refers to a lumbar puncture, (2) refers to an electroencephalogram, and (3) is not necessary. 12. (2, 3, 4, 5) are correct. During the computed tomography scan, the patient must lie still on a movable table. Noncontrast scans take approximately 10 minutes; contrast scans take between 20 and 30 minutes. Patients who are receiving contrast media should be warned that they may feel a sensation of warmth following the injection; warmth in the groin area may make them feel as though they have been incontinent of urine. Nausea, diaphoresis, itching, or difficulty breathing may indicate allergy to the dye and should be reported immediately to the physician or nurse practitioner. Sedation may be required for patients who are agitated or disoriented. 13. The area where would the nurse would focus assessment of the motor impulses from the glossopharyngeal and vagal nerves.