1. Chapter 42
Care of Patients with Problems of the Central Nervous System: The Brain
Magnetic resonance image (MRI) of a brain with Parkinson disease.
From Easton, S. (2014). An Introduction to Radiography. 3rd Ed. Edinburgh: Churchill Livingstone.

2. Headaches Types, etiologies, symptoms Interventions Drug therapy
Migraine
Cluster
Interventions
Drug therapy
Complementary and alternative therapies

3. Seizures vs. Epilepsy Seizure Epilepsy Generalized Partial
Unclassified
Secondary seizures
Epilepsy
Primary or idiopathic

4. Seizure Risks May result from: Metabolic disorders
Acute alcohol withdrawal
Electrolyte disturbances
Heart disease
High fever
Stroke
Substance abuse

5. Seizure Precautions Oxygen Suction equipment Airway IV access
Side rails up and padded

6. Seizure Management Depends on type of seizure
Observation and documentation
Patient safety
Side-lying position
No restraints
Never force anything into the patient’s mouth

7. Acute Seizure Management
Medication depends on type of seizure
Medication for tonic-clonic seizure activity may include:
Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

8. Status Epilepticus
Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency!
Establish airway
ABGs
IV push lorazepam, diazepam
Rectal diazepam
Loading dose IV phenytoin
ABGs, Arterial blood gases.

9. Drug Therapy
Evaluate most current blood level of medication, if appropriate
Be aware of drug-drug/drug-food interactions
Maintain therapeutic blood levels for maximal effectiveness
Do not administer warfarin with phenytoin
Document and report side/adverse effects

10. Patient & Family Education
Compliance with AEDs
Social service resources to assist with medication costs
Evaluation of employment safety needed to decrease risks
Vocational rehabilitation may be subsidized
AEDs, Antiepileptic drugs.

11. Surgical Management Vagal nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Partial corpus callosotomy

12. Meningitis
Viral
Bacterial

13. Physical Assessment & Clinical Manifestations
General symptom
Fever
Neurologic symptoms
Headache
Photophobia
Indications of increased ICP
Nuchal rigidity
Positive Kernig’s, Brudzinski’s signs
Decreased mental status
Focal neurologic deficits
GI symptoms
Nausea and vomiting
ICP, Intracranial pressure.

14. Laboratory Assessment of Meningitis
CSF analysis
CT scan
Blood cultures
Counterimmunoelectrophoresis
Polymerase chain reaction
CBC
X-rays to determine presence of infection
CBC, Complete blood count; CSF, cerebrospinal fluid; CT, computed tomography.

15. Drug Therapy Broad-spectrum antibiotic Hyperosmolar agents
Anticonvulsants
Steroids (controversial)
Prophylaxis treatment for those in close contact with meningitis-infected patient

16. Encephalitis Pathophysiology Causes Preventive measures
Physical assessment
Drug therapy
Complications

17. Parkinson Disease Pathophysiology Causes Preventive measures
Physical assessment
Drug therapy
Drug toxicity interventions
Priority of care and management
Medical
Surgical

18. Parkinson Disease (Cont.)
The masklike facial expression typical of patients with Parkinson disease.

19. Alzheimer’s Disease Pathophysiology Stages Symptoms Diagnostic testing
Structural changes in brain
Stages
Symptoms
Diagnostic testing
Physical assessment
Priority of care
Interventions and support (patient and caregiver)

20. Huntington Disease Pathophysiology Causes Physical assessment
Drug therapy
Health teaching – Include psychosocial support resources

21. What is the nurse’s best response?
The wife of a patient recently diagnosed with Alzheimer’s disease asks the nurse if there is a cure for her husband’s illness.
What is the nurse’s best response?
Eating a balanced diet that includes lots of soy products can prevent Alzheimer’s disease.
Cholinesterase inhibitor drugs such as donepezil (Aricept) can slow the progression of the disease.
Removal of neuritic plaques can prevent vascular degeneration and improve brain cell function.
Decreasing the levels of neurotransmitters in the brain can slow the progression of the disease.
Answer: B
Cholinesterase inhibitors are approved for treating Alzheimer’s disease symptoms. They work to improve cholinergic neurotransmission in the brain by delaying the destruction of acetylcholine (ACh) by the enzyme acetylcholinesterase. This slows the onset of cognitive decline in some patients.

22. (Cont.)
The wife states that her husband is able to perform most of his own ADLs, and wants to keep her husband safely and independently functioning in their home as long as possible.
To help her husband maintain safe independence, which action should the nurse recommend?
Ensure that door locks can be easily opened by the patient.
Take the patient out into crowds of people as often as possible.
Vary times for meals, bedtime, and getting up in the morning.
Place outfits on hangers, then allow the patient to choose what to wear.
Answer: D
Allowing the patient to choose what to wear supports the patient’s independence because he can still dress himself. The other responses are not appropriate strategies for patients with Alzheimer’s disease. Crowds of people would further confuse the patient. Patients with Alzheimer’s disease do much better with a consistent routine. Easily unlocked doors may lead to the patient wandering off.
ADLs, Activities of daily living.

23. (Cont.)
At a 6-month follow-up appointment, the wife states that the patient occasionally has difficulty finding the correct words to use when he is communicating.
What term does the nurse use to document this assessment data?
Apraxia
Aphasia
Anomia
Agnosia
Answer: C
Anomia is the inability to find words. Apraxia is the inability to use words or objects correctly. Aphasia is the inability to speak or understand. Agnosia is the loss of sensory comprehension.

24. (Cont.)
At an 18-month follow-up appointment, the wife states that her husband seems depressed most of the time and has become less talkative over the past few months.
Which medication could be helpful for this patient’s symptoms?
Sertraline (Zoloft)
Amitriptyline (Elavil)
Imipramine (Tofranil)
Desipramine (Norpramin)
Answer: A
Some patients with Alzheimer’s disease develop depression and can be treated with antidepressant drugs. Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) and sertraline (Zoloft) are usually prescribed.

25. (Cont.)
The patient’s wife calls the physician’s office to report that she is concerned, because the last time her husband took a walk in the neighborhood where they have lived for 35 years, he got lost and a neighbor brought him back home.
What measures should the nurse recommend for patient safety? (Select all that apply.)
“Enroll him in the Safe Return program.”
“Have him wear an ID bracelet or badge at all times.”
“Place him in a geri-chair when you can’t be with him.”
“Ask your doctor to prescribe a sedative drug to keep him calm.”
“Take him for a walk two or three times a day in different neighborhoods.”
Answer: A, B, C
Positive interventions for coping with restlessness and wandering include having the patient wear an ID bracelet, enrolling him in a Safe Return program, and the use of a geri-chair. Physical and chemical restraints such as sedatives should only be used as a last resort. Taking him for walks in different neighborhoods may increase confusion.

26. (Cont.)
During the call, the wife states that she must go out of town for 3 days to care for an elderly cousin, and she is concerned about her husband’s care.
Which nursing response is appropriate?
“Can you return home sooner than 3 days?”
“Why are you choosing to care for your cousin instead of your spouse?”
“Your husband only has mild Alzheimer’s disease, so staying home alone is acceptable.”
“There are organizations that may be able to provide an interim caretaker for your husband.”
Answer: D
The patient has stage II (moderate) Alzheimer’s disease, based on his symptoms, and needs supervision. Providing information about organizations that may be able to help care for him is most appropriate. Asking the patient’s wife to change her travel plans is nontherapeutic and does not address the underlying concern for the patient’s safety.

27. Audience Response System Questions
Chapter 42
Audience Response System Questions 27

28. Question 1
The nurse is caring for a 53-year-old woman with new onset of migraine headaches with photophobia. What is a priority nursing intervention?
Effective pain management
Identification of triggers that cause headaches
Management of associated nausea and vomiting
Education of cardiovascular and stroke signs and symptoms
Answer: D
Rationale: It is important to teach women older than 50 years who have migraines about the risk factors for cardiovascular disease. Encourage them to notify their health care provider if they experience symptoms such as facial drooping, arm weakness, or difficulties with speech. Other priority interventions include education on the three R’s: Recognize migraine symptoms, Respond and see the health care provider, and Relieve pain and associated symptoms. (Source: Accessed August 11, 2011, from 28

29. Question 2
When caring for a patient with Parkinson disease, the nurse understands that progressive difficulty with which factor is a primary expected outcome?
Nutrition
Elimination
Motor ability
Effective communication
Answer: C
Rationale: Parkinson disease is a progressive debilitating neurodegenerative disease affecting motor ability. As the disease progresses, the patient may experience difficulty with communication, nutrition, ADLs, elimination, and cognition.

30. Question 3
The family of a patient asks if the diagnosis of Alzheimer’s disease is unusual. The nurse understands that Alzheimer’s disease affects how many people in the United States?
1.5 million
2.4 million
3.2 million
5.1 million
Answer: D
Rationale: Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer’s disease. (Source: Accessed April 27, 2014, from