NEURO

• What are the classifications of the commonly prescribed eye drops for glaucoma? Answers:

  • Parasympathomimetics for pupillary constriction
  • Beta-adrenergic receptor-blocking agents to inhibit formation of aqueous humor
  • Carbonic anhydrase inhibitors to reduce aqueous humor production
  • Prostaglandin agonists to increase aqueous humor outflow
• Identify 2 types of hearing loss.

  1. Conductive (transmission of sound to inner ear is blocked)
  2. Sensorineural (damage to 8th cranial nerve) 

  
• Write 4 nursing interventions for the care of the blind person

  1. Announce presence clearly
  2. Call by name
  3. Orient carefully to surroundings
  4. Guide by walking in front of client with his/her hand in your elbow
• Write 4 nursing interventions for the care deaf person.

  1. Reduce distraction before beginning conversation
  2. Look and listen to the client
  3. Give the client full attention if they are a lip reader
  4. Face the client directly. 
• In your own words describe the Glasgow Coma Scale.

  • An objective assessment of the level of consciousness based on a score of 3 to 15
  • Scores of 7 or less indicative of coma
• List 4 nursing diagnoses for the comatose client in order of priority.

  1. Ineffective breathing pattern
  2. Ineffective airway clearance
  3. Impaired gas exchange
  4. Decreased cardiac output
• State 4 independent nursing interventions to maintain adequate respirations, airway, and oxygenation in the unconscious client.

  1. Position for maximum ventilation (prone or semi-prone and slightly to one side)
  2. Insert airway if tongue obstructing
  3. Suction airway efficiently
  4. Monitor arterial pO2 and pCO2 and hyperventilation with 100% oxygen before suctioning
• Who is at risk for cerebral vascular accidents?

  Persons with history of:

  1. Hypertension
  2. Previous TIAs
  3. Cardiac disease (atrial flutter/fibrillation)
  4. Diabetes
  5. Oral contraceptive use
  6. Elderly
• Complications of immobility include the potential for thrombus development. State 3 nursing interventions to prevent thrombi.

  1. Frequent range of motion exercises
  2. Frequent (q2h) position changes
  3. Avoidance of positions which decrease venous return 
• List 4 rationales for the appearance of restlessness in the unconscious client.

  1. Anoxia
  2. Distended bladder
  3. Covert bleeding
  4. A return to consciousness 
• What nursing interventions prevent corneal drying in a comatose client?

  • Irrigation of eyes PRN with sterile prescribed solution
  • Application of ophthalmic ointment q8h
  • Close assessment for corneal ulceration/drying
• When a comatose client on IV hyperalimentation begin to receive tube feedings instead?

  When peristalsis resumes as evidenced by active bowel sounds, passage of flatus or bowel movement. 
• What is the most important principle in a bowel management program for a neurologic client?

  Establishment of REGULARITY 
• Define cerebral vascular accident.

  A disruption of blood supply to a part of the brain, which results in sudden loss of brain function. 
• A client with a diagnosis of CVA presents with symptoms of aphasia, right hemiparesis, but no memory or hearing deficit. In what hemisphere has the client suffered a lesion?

  Left
• What are the symptoms of spinal shock?

  • Hypotension
  • Bladder and bowel distention
  • Total paralysis
  • Lack of sensation below lesion
• What are the symptoms of autonomic dysreflexia?

  • Hypertension
  • Bladder and bowel distention
  • Exaggerated autonomic responses
  • Headache
  • Sweating
  • Goosebumps
  • Bradycardia
• What is the most important indicator of increased ICP?

  A change in the level of responsiveness
• What vital sign changes are indicative of increased ICP?

  • Increased BP
  • Widening pulse pressure
  • Increased or decreased pulse
  • Respiratory irregularities
  • Temperature increase
• A neighbor calls the neighborhood nurse stating that he was knocked hard to the floor by his very hyperactive dog. He is wondering what symptoms would indicate the need to visit an emergency room. What should the nurse tell him to do?

  • Call his physician now and inform him/her of the fall.
  • Symptoms needing medical attention would include:
  • vertigo, confusion or any subtle behavioral change, headache, vomiting, ataxia (imbalance), or seizure.
• What activities and situations should be avoided that increase ICP?

  • Change in bed position
  • Extreme hip flexion
  • Endotracheal suctioning
  • Compression of jugular veins
  • Coughing
  • Vomiting
  • Straining of any kind
• How do Hyperosmotic agents (osmotic diuretics) used to treat intracranial pressure act?

  • Dehydrate the brain and reduce cerebral edema by holding water in the renal tubules to prevent reabsorption
  • Drawing fluid from the extravascular spaces into the plasma
• Why should narcotics be avoided in clients with neurologic impairment?

  Narcotics mask the level of responsiveness as well as pupillary response. 
• Headache and vomiting are symptoms of many disorders. What characteristics of these symptoms would alert the nurse to refer a client to a neurologist?

  • Headache which is more severe upon awakening
  • Vomiting not associated with nausea are symptoms of a brain tumor
• How should the head of the bed be positioned for post-craniotomy clients with infratentorial lesions?

  • Infratentorial –FLAT
  • Supratentorial –elevated 
• Is multiple sclerosis thought to occur because of an autoimmune process?

  YES 
• Is paralysis always a consequence of spinal cord injury?

  NO 
• What types of drugs are used in the treatment of myasthenia gravis?

  Anticholinesterase drugs, which inhibit the action of cholinesterase at the nerve endings to promote the accumulation of acetylcholine at receptor sites, which should improve neuronal transmission to muscles.