Nursing Care of Clients with Neurosensory Disorders – Flashcards

1.Central and Peripheral Nervous System Disorders: 2.Sensory Disorders

Increased Intracranial Pressure Disorders Meningitis Seizure Disorders Parkinson's Disease Alzheimer's Disease Cerebrovascular Accident Spinal Cord Injuries Multiple Sclerosis and Amyotrophic Lateral Sclerosis Guillain-Barré Syndrome and Myasthenia Gravis

Disorders of the Eye Hearing Loss and Middle and Inner Ear Disorders

- abrupt, abnormal, excessive and uncontrolled electrical discharge of neurons within the brain that may cause alterations in the level of consciousness and/or changes in motor and sensory ability and/or behavior - Epilepsy - generalized (Loss of consciousness occurs with involvement of both cerebral hemispheres) - partial or focal/local (Seizure activity begins in one cerebral hemisphere) - unclassified or idiopathic (occur for no known reason)

- Genetic predisposition - Acute febrile state - Head trauma, cerebral edema, brain tumor - Infection, metabolic disorders, hypoxia, fluid and electrolyte imbalances - Acute drug and alcohol withdrawal - Abrupt cessation of antiepileptic medications (AEDs) - Triggering Factors: + Increased physical activity +Excessive stress + Overwhelming fatigue + Acute alcohol ingestion + Excessive caffeine intake + Exposure to flashing lights + Specific chemicals, such as cocaine, aerosols and inhaling glue products

1. Tonic-clonic seizure - It may begin with an aura (alteration in vision, smell, or emotional feeling). - Tonic phase - A 15- to 20-second episode of stiffening of muscles, loss of consciousness, cessation of breathing, dilated pupils and development of cyanosis. - Clonic phase - A 1- to 2-min episode of rhythmic jerking of the extremities, irregular respirations, biting of the cheek or tongue and bladder and bowel incontinence may occur. - Postictal phase: May last for several hours. Unconsciousness may last for 30 min at which time the client awakens slowly and is usually confused and disoriented. Reports of headache, fatigue, and muscle aches are not uncommon. Clients may have no memory of what happened just before the seizure. 2. Absence seizure - Absence seizures are most common in children. - The seizure consists of a loss of consciousness lasting a few seconds, accompanied by blank staring (appears to be daydreaming) and associated automatisms (behaviors that clients are unaware of, such as lip-smacking or picking at clothes). - Baseline neurological function is resumed after seizures, with no apparent sequela. - Clients are often unaware seizure is occurring.

1. Complex partial seizure - Complex partial seizures have associated automatisms (behaviors that clients are unaware of, such as lip-smacking or picking at clothes). - The seizure can cause a loss of consciousness for several minutes. - Amnesia may occur immediately prior to and after the seizure. 2. Simple partial seizures - Consciousness is maintained throughout simple partial seizures. - Seizure activity may consist of unusual sensations, a sense of déjà vu, autonomic abnormalities, such as changes in heart rate and abnormal flushing, unilateral abnormal extremity movements, pain, or offensive smell.

1. Protect clients from injury. - Move furniture away. - Hold the client's head in lap if she is on the floor. - Position clients to provide a patent airway. - Turn clients to the side to decrease the risk of aspiration. - Be prepared to suction oral secretions. - Loosen restrictive clothing. - Do not attempt to restrain clients. - Do not attempt to open jaw or insert airway during seizure activity (may damage teeth, lips, and tongue). Do not use padded tongue blades. 2. Document onset and duration of seizure and client findings/observations prior to, during, and following the seizure (level of consciousness, apnea, cyanosis,

- Maintain clients in a side-lying position to prevent aspiration and to facilitate drainage of oral secretions. - Check vital signs. - Check for injuries. - Perform neurological checks. - Allow clients to rest if necessary. - Reorient and calm clients (may be agitated or confused). - Institute seizure precautions including placing the bed in the lowest position and padding the side rails to prevent future injury. - Determine if the client experienced an aura, which can possibly indicate the origin of seizure in the brain. - Try to determine possible trigger.

Antiepileptic drugs (AEDs)

1. diazepam (Valium) 2. phenytoin (Dilantin) 3. carbamazepine (Tegretol) 4. valproic acid (Depakene) 5. gabapentin (Neurontin) 6. fosphenytoin sodium (Cerebyx)

- Monitor therapeutic plasma levels. Be aware of therapeutic levels for medications prescribed. Notify the provider of results - Advise clients that treatment provides for control of seizures, not cure of the disorder. - Encourage clients to keep a seizure frequency diary to monitor the effectiveness of therapy. - Advise clients to take medications as prescribed, usually the same time every day. If a dose is forgotten, tell them to take the next scheduled dose. Extra doses should not be taken. - Advise clients to not stop taking medications without consulting the provider. Sudden cessation of medication may result in seizures. - Advise clients to avoid hazardous activities (driving, operating heavy machinery) until seizures are fully controlled. - Instruct clients not to take any unprescribed medications and to be aware of drug-drug and drug-food interactions (decreased effectiveness of oral contraceptives). - Advise clients of childbearing age to avoid pregnancy, as medications may cause birth defects and congenital abnormalities.

placement of a vagal nerve stimulator and excision of the portion of the brain causing the seizures for intractable seizures

- Surgical Interventions for seizure - indicated for simple or complex partial seizures. - contraindicated for clients with generalized seizures.

complication of seizure is prolonged seizure activity occurring over a 30-min time frame related to decreased oxygen levels, inability of the brain to return to normal functioning, and continued assault on neuronal tissue Call for assistance. Maintain an airway, provide oxygen, and monitor pulse oximetry. Assist with emergency care as appropriate

2 3 4 Clients should be instructed to avoid alcohol and flashing lights, which may trigger seizure activity. The client should also wear an ID bracelet or necklace to alert others to the condition if a seizure occurs. The client should be instructed to take a shower instead of a tub bath to prevent drowning should a seizure occur. And, it is not necessary for the client to avoid foods that are high in purine.

A The greatest risk to the client is aspiration during the postictal phase. Therefore, the priority intervention is to keep the client in a side-lying position so secretions can drain from the mouth. Taking the client's vital signs, reorienting the client to the environment, and checking the client for injuries are important, but are not the priority.

C The client should not take an extra dose or miss any remaining doses for the day. It is important that anticonvulsant medication be taken on a regular basis to maintain a consistent blood level. Taking a double dose increases the risk of toxicity. The client should wait and take the next regularly scheduled dose if it is within 4 hr of the next dose

B Products containing caffeine should be avoided 6 to 9 hr prior to the EEG, but decaffeinated products and food may be consumed. Hair should be washed prior to the procedure and the client should not sleep the night prior if possible.

- a progressively debilitating disease that grossly affects motor function. - characterized by four primary symptoms -tremor, muscle rigidity, bradykinesia (slow movement), and postural instability. - occur due to overstimulation of the basal ganglia by acetylcholine.

increasing the amount of dopamine or decreasing the amount of acetylcholine in a client's brain.

Stage 1 - Unilateral shaking or tremor of one limb. Stage 2 - Bilateral limb involvement makes walking and balance difficult. Stage 3 - Physical movements slow down significantly, affecting walking more. Stage 4 - Tremors may decrease but akinesia and rigidity make day-to-day tasks difficult. Stage 5 - Client is unable to stand or walk, is dependent for all care, and may exhibit dementia.

Onset of symptoms between age 40 to 70 More common in men Genetic predisposition Exposure to environmental toxins

Report of fatigue Report of decreased manual dexterity over time Stooped posture Slow, shuffling, and propulsive gait Slow, monotonous speech Tremors/pill-rolling tremor of the fingers Muscle rigidity Bradykinesia/akinesia Mask-like expression Autonomic symptoms (orthostatic hypotension, flushing, diaphoresis) Difficulty chewing and swallowing Drooling Dysarthria Progressive difficulty with ADLs Mood swings Cognitive impairment (dementia)

-Administermeds at prescribed times. -Monitor swallowing and maintain adequate nutrition. +Request a referral for a speech-language pathologist to assess swallowing if clients demonstrate a risk for choking. +Consult the client's dietician for appropriate diet. +Document the client's weight at least weekly. +Keep a diet intake log. +Encourage fluids and document intake. +Provide smaller, more frequent meals. +Add commercial thickener to thicken food. +Provide supplements as prescribed. - Maintain client mobility for as long as possible. + Encourage exercise, such as yoga (may improve mental status as well). +Encourage the use of assistive devices as the disease progresses. +Encourage range-of-motion (ROM) exercises. +Reinforce to clients to stop occasionally when walking to slow down speed and reduce the risk for injury. +Pace activities by providing rest periods. + Assist clients with ADLs as needed (hygiene, dressing). - Promote client communication for as long as possible. +Instruct clients to use facial muscle strengthening exercises. +Encourage clients to speak slowly and to pause frequently. +Use alternate forms of communication as appropriate. +Request a referral for a speech-language pathologist. - Monitor a client's mental and cognitive status. +Observe for signs of depression and dementia. +Provide a safe environment (no throw rugs, encourage the use of an electricrazor). +Determine personal and family coping with the client's chronic, degenerative disease. +Provide a list of community resources (support groups) to the client and the client's family. +Request a referral for a social worker or case manager as the condition advances (financial issues, long-term home care, and respite care).

1.Dopaminergics 2.Dopamine agonists 3 Anticholinergics 4. Catechol O-methyltransferase (COMT) inhibitors 5. Antivirals

Meds for PD, PO increasing dopamine levels in the basal ganglia levodopa (Dopar) may be combined with carbidopa (Sinemet) to decrease peripheral metabolism of levodopa, requiring a smaller dose to make the same amount available to the brain. Side effects are subsequently less. Monitor for the "wearing-off" phenomenon and dyskinesias (problems with movement), which can indicate the need to adjust the dosage or time of administration or the need for a medication holiday Due to medication tolerance and metabolism, the client's dosage and administration times must be adjusted to avoid periods of poor mobility

Meds for PD bromocriptine (Parlodel) pramipexole (Mirapex), activate the release of dopamine. May be used in conjunction with a dopaminergic for better results. Monitor for orthostatic hypotension, dyskinesias, and hallucinations.

Med for PD benztropine (Cogentin) trihexyphenidyl (Artane) help control tremors and rigidity. Monitor for anticholinergic effects (dry mouth, constipation, urinary retention).

Med for PD entacapone (Comtan) decrease the breakdown of levodopa, making it more available to the brain as dopamine. It can be used in conjunction with a dopaminergic and dopamine agonist for better results. Monitor for dyskinesia/hyperkinesia when used with levodopa. Check for diarrhea. Reassure clients that dark urine is an expected finding.

Med for PD amantadine (Symmetrel) stimulate the release of dopamine and prevent its reuptake. Monitor for swollen ankles and discoloration of the skin.

1. Stereotactic pallidotomy 2. Deep brain stimulation

Surgical interventions for PD ■■ Stereotactic pallidotomy is the destruction of a small portion of the brain within the globus pallidus through the use of brain imaging and electrical stimulation. ■■ The target area is identified with a CT scan or an MRI. ■■ Mild electrical stimulation is provided through a burr hole to a target area. ■■ Client is assessed for a decrease in tremors and muscle rigidity. ■■ When a decrease is elicited, a temporary lesion is formed and the client is reassessed. ■■ If symptomatic relief is demonstrated, a permanent lesion is made.

Surgical interventions for PD ■■ An electrode is implanted in the thalamus. ■■ A current is delivered through an implanted pacemaker generator. ■■ The goal of the current is to interfere with electrical conduction in "tremor cells" decreasing tremors.

1. Aspiration pneumonia - As PD advances in severity, alterations in chewing and swallowing will worsen, increasing the risk for aspiration. - Use swallowing precautions to decrease the risk for aspiration. - Follow the individual dietary plan based on the speech-language pathologist's recommendations. - Have a nurse in attendance when the client is eating. - Encourage clients to eat slowly and chew thoroughly before swallowing. - Feed clients in an upright position and have suction equipment on standby. 2. Altered cognition (dementia, memory deficits) - Clients in advanced stages of PD may exhibit altered cognition in the form of dementia and memory loss. - Acknowledge the client's feelings. - Provide for a safe environment.

b c e Clients with PD experience pill-rolling tremors of the fingers, shuffling gait, and lack of facial expressions. Decreased vision, high pitched, squeaky voice, and increased periods of sleep are not a direct effect of PD. Lack of sleep, rather than frequent periods of sleep, is experienced.

C Increased difficulty walking may indicate the client is having periods when the medication is "wearing off" and adjustment of dosage is indicated. The other options do not describe concerns related to dosage of the medication.

A Orthostatic hypotension is a common side effect of bromocriptine. Rising slowly will decrease the risk of dizziness and lightheadedness. Bromocriptine does not have anticholinergic effects, so it is not necessary to instruct the client to increase dietary fiber and fluid intake or chew sugarless gum. Wearing sunscreen when outdoors does not relate to the side effects of bromocriptine.

C Using the airway, breathing, circulation priority-setting framework, suction equipment should be placed at the client's bedside due to the continued risk for aspiration and subsequent airway obstruction. Assisting the client to the restroom and with dressing, and observing the IV site for inflammation should all be included in the plan of care, but are not the priority intervention.