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283 Comp 3 Review
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11/15/23, 11:01 AM 283 Comp 3 Review283 Comp 3 Review
I. Neuro
A. Epilepsy – page 839-840
a. Seizures may occur in response to meningeal irritation and
increased ICP.
b. Prepare for lumbar puncture which will analysis CSF and
implement seizure precautions
c. Epilepsy is the chronic recuring abnormal brain electrical
activity resulting in two or more seizures.
d. Seizures resulting from substance withdrawal or fever are
not considered epilepsy.
e. TX: carbamazepine- anticonvulsant medication use to treat
epilepsy, also used to treat schizophrenia (second line
agent)
i. Carbamazepine: avoid pregnancy, avoid grapefruit,
Carbamazepine blood levels and the CBC should be
monitored during therapy. The client is at risk for
bone marrow depression while taking carbamazepine
and should notify the provider for a sore throat or
other manifestations of an infection. Can cause
steven- Johnson syndrome which can be fatal, notify
HCP if rash occurs, can cause CNS effects (drowsiness
or dizziness) can occur early, and should avoid
activities requiring alertness.
B. Lumbar Spinal Surgery complications – page
a. Spinal surgery- Report clear fluid leaking
b. Post op lumbar puncture reports throbbing pain what
actions should the nurse take?
c. Assist pt to supine position to relieve headache following
lumbar puncture
d. Administer opioid medications for pt reporting headache
pain.
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e. Encourage increase fluid intake to maintain positive fluid
balance which can relieve a headache following lumbar
puncture.
f. Monitor puncture site for CSF leak. The “halo” sign, clear or
yellowish ring surrounding a spot of blood indicated leakage
of CSF and priority to follow up.
C. Meningitis – page 847-848
a. Risk for bacterial meningitis is related to bacterial- based
infection (otitis media, pneumonia, sinusitis) in which the
infectious micro-organism is Neisseria meningitidis,
streptococcus pneumonia, or haemophilus influenza.
b. Droplet isolation precautions as soon as meningitis is
suspected
c. Carbamazepine anticonvulsant medication
d. Implement seizure precautions
e. Lumbar puncture will analysis the pt CSF to diagnose
meningitis.
f. Droplet precautions need a private room (if possible) and
standard mask worn by anyone in room within 3 ft of the
patient.
g. Positive Brudzinski sign, positive kernig sign
h. Phenytoin med given if antiseizure is ineffective, give slowly,
give no more than 50mg/ min. Do not mix with glucose w
0.9% sodium chloride, monitor for bradycardia and heart
block
D. Peak/Trough- Peak done 30min after infusion, Trough is done right
before next med administration
E. Multiple Sclerosis, symptoms – page 843-844, 855-856
a. Impaired and worsening function of voluntary muscles
b. Characteristics by remission and exacerbation
c. Teach to conserve energy and to avoid overexertion, stress,
extreme temp, humidity, and people with infections
d. S/S= fatigue, muscle spasms, blurred or double vision,
scotomas, nystagmus, paresthesia, areflexic (flaccid) or
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spastic bladder, decreased sexual function, intention
tremor, gait changes.
e. Tx: Muscle relaxers S/E of med: dizziness, drowsiness,
hypotension, nausea.
f. Teach to avoid OTC drugs that could cause complications
g. The onset of MS is typically between 20 and 40 years of age.
MS occurs twice as often in females. There is a family
history (first-degree relative) of MS in many cases. Research
shows association with the interleukin (IL)-7 and IL-2
receptor genes.
h. Because MS is an autoimmune disease, there are factors
that trigger relapses:
i. Viruses and infectious agents
j. Living in a cold climate
k. Physical injury
l. Emotional stress
m. Pregnancy
n. Fatigue
o. Overexertion
p. Temperature extremes
q. Hot shower/bath
r. MS is a chronic disease with no known cure that progresses
in severity over time. Initial findings can be so vague that
diagnosis is not made for several years. Some forms of MS
are aggressive and can shorten the lifespan. In most cases,
life expectancy is not adversely affected by this disease.
These clients may direct their anger toward self, others, or
the current circumstances. You should be able to recognize
examples of the various stages of grief
F. Spina Bifida – page 472
a. Etiology- This is considered a central nervous system defect
resulting from the failure of the neural tube to close during
embryonic development. Folic acid is recommended to
prevent this defect from occurring. Associated deficits
include sensorimotor disturbance, dislocated hips, talipes
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equinovarus (clubfoot), and hydrocephalus. Surgery is
performed soon after birth.
b. TX: Monitor for ICP. Measure head circumference asses
anterior fontanel for bulging. Protect the sac with a sterile
dressing, moist with normal saline nonadherent. Change
dressing often to keep moist, diapering may be avoided
until the defect is repaired. Assess sac for redness, clear or
purulent drainage, abrasions, irritations, and infection.
Elevated temp, irritability, lethargy, and nuchal rigidity.
Place prone, head to the side for feeding. Assess for hip or
joint deformities. Give abx pre and post-op.
c. Teach parents: positioning, feeding, skincare, ROM.
Instituting a bladder program and performing clean
intermittent catheterization. Administering antispasmodics
to increase bladder capacity and improve continence. Bowel
program including high fiber increased fluids and
suppositories. High risk for latex allergy and rubber
products.
G. Stroke - page 841-843
a. Pt with A-fib at risk for stoke/PE, Pt with increased
restlessness
b. PT with a-fib must receive anticoagulation for 4-6 wks prior
to cardioversion therapy, to prevent dislodgment of thrombi
into the bloodstream.
c. First ABC, assess within 10 min
d. Alteplase within 3 hours of onset
e. Aspirin325mg within the first 24-28hr of onset of stroke
(not within 24hrs of Alteplase)
f. F.A.S.T (FACE drooping, ARM weakness, SPEECH or language
difficulty, TIME to call 911)
Thrombotic strokes occur secondary to the development of a blood clot on an
atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia
distal to the occlusion. Manifestations of a thrombotic stroke evolve over a period of several hours
to days.
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