NR 325 Exam 2

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Exam #2 Topics Review

Neurological Conditions

Head Injury

When caring for a patient with a head injury, nurses must anticipate potential complications such as seizures. Preventive administration of anticonvulsant medications is common practice to reduce this risk. Clinical indicators of head trauma include cerebrospinal fluid (CSF) leakage from the nose or ears and periorbital or postauricular discoloration (commonly referred to as “raccoon eyes” or “Battle’s sign”). Rapid recognition and intervention are critical to prevent secondary injury.

Increased Intracranial Pressure (ICP)

Increased ICP is a potentially life-threatening condition that requires vigilant monitoring. Symptoms may include headache, altered mental status, pupillary changes, nausea, vomiting, and changes in respiratory patterns. Management strategies focus on elevating the head of the bed to 30 degrees to promote venous drainage, maintaining normothermia, and avoiding activities that increase intra-abdominal or intrathoracic pressure. ICP is often measured using intraventricular catheters or other monitoring devices. Prompt intervention helps prevent brain herniation and permanent neurological deficits.

Stroke

Strokes are classified into ischemic (caused by a clot) or hemorrhagic (caused by a ruptured vessel). Immediate diagnostic imaging, typically a CT scan, helps differentiate between the two. Management priorities include maintaining airway patency, conducting a swallow evaluation to prevent aspiration, and initiating thrombolytic therapy (for ischemic strokes) within the recommended timeframe. Nurses must recognize differences between left-sided and right-sided stroke deficits to tailor care strategies—such as addressing speech difficulties, neglect syndromes, or impaired motor control.

Transient Ischemic Attack (TIA)

A transient ischemic attack, sometimes called a “mini-stroke,” presents with stroke-like symptoms that resolve within 24 hours. TIAs serve as warning signs of an impending stroke and require immediate evaluation and intervention to reduce long-term risk.

Seizures

Seizures may be focal or generalized, with presentations ranging from brief lapses in awareness to tonic-clonic activity. Management includes maintaining a safe environment (e.g., padding side rails, positioning the patient to maintain airway patency) and administering antiepileptic medications as prescribed. In cases of status epilepticus, rapid intervention with IV benzodiazepines or other agents is required. Long-term management involves tailoring therapy based on seizure type and patient response.

Meningitis

Meningitis is an infection of the meninges characterized by fever, headache, neck stiffness, and photophobia. Diagnosis is typically confirmed via lumbar puncture, though this procedure should be deferred if increased ICP is suspected. Immediate antibiotic therapy is critical for bacterial meningitis, while viral meningitis is usually self-limiting. Supportive care, including seizure precautions and fluid balance management, is essential.

Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder characterized by tremors, bradykinesia, muscle rigidity, and postural instability. Management includes pharmacologic treatment such as levodopa-carbidopa and non-pharmacologic interventions like physical therapy, fall prevention strategies, and speech therapy for communication support.

Alzheimer’s Disease

Alzheimer’s disease, a form of dementia, involves progressive memory loss, impaired cognitive function, and behavioral changes. Nursing management focuses on maintaining patient safety, supporting daily living activities, and educating caregivers. Interventions also include structured routines, environmental modifications, and pharmacologic agents to slow symptom progression.

Other Conditions Affecting Brain and Nervous System

Intracranial Pressure (ICP)

Normal ICP values range from 5 to 15 mmHg. Elevated ICP can occur due to edema, hemorrhage, or traumatic brain injury. Management includes frequent monitoring, administration of osmotic diuretics such as mannitol, and ensuring proper oxygenation and perfusion.

Cranial Nerves

A strong understanding of cranial nerves and their functions is crucial for neurological assessment. For example, the Romberg Test evaluates balance and cerebellar function. Assessment of cranial nerves also assists in detecting stroke deficits, head injury complications, or progressive neurological disorders.

Myasthenia Gravis

This autoimmune disorder leads to weakness in voluntary muscles due to impaired neuromuscular transmission. A Tensilon test is historically used for diagnosis, though antibody testing and electromyography are now more common. Management focuses on anticholinesterase medications, immunosuppressants, and in severe cases, plasmapheresis. Respiratory monitoring is a priority due to the risk of paralysis affecting breathing muscles.

Amyotrophic Lateral Sclerosis (ALS)

ALS is a progressive condition that results in muscle wasting and weakness, eventually impairing respiratory function. Although there is no cure, interventions focus on supportive care, respiratory assistance, and symptom management to improve quality of life.

Guillain-Barré Syndrome

Guillain-Barré syndrome involves acute, ascending paralysis often triggered by infection. Priority nursing care includes monitoring respiratory status, providing supportive therapy, and initiating treatments such as intravenous immunoglobulin (IVIG) or plasmapheresis.

Multiple Sclerosis (MS)

MS is an autoimmune demyelinating disorder that leads to neurological impairment. Symptoms include vision changes, weakness, and impaired coordination. Management may include corticosteroids during acute exacerbations, disease-modifying therapies, and physical or occupational therapy.

Delirium

Delirium presents as acute confusion, often caused by infection, medications, or metabolic disturbances. Management strategies emphasize identifying and treating the underlying cause, ensuring patient safety, and minimizing environmental stimuli that may worsen disorientation.

Gastrointestinal and Hepatic Conditions

Spinal Cord Injury

The effects of spinal cord injury vary depending on the level of damage. For instance, injuries at T12 may preserve some lower extremity function, whereas injuries at C9 can severely impact respiratory function. Nursing care emphasizes preventing complications such as pressure ulcers, ensuring adequate bowel and bladder function, and engaging rehabilitation services, including physical, occupational, and speech therapy.

Gallbladder Disease

Conditions such as cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation) may require surgical intervention, typically a laparoscopic cholecystectomy. Postoperative care includes monitoring for infection, managing pain, and encouraging gradual dietary advancement.

Pancreatitis

Acute pancreatitis often presents with severe abdominal pain and may be associated with hypocalcemia. Chronic pancreatitis involves long-term inflammation leading to digestive enzyme insufficiency. Management includes pain control, nutritional support, enzyme replacement therapy, and close monitoring of laboratory values.

Hepatitis

Hepatitis refers to liver inflammation caused by viruses, toxins, or autoimmune disorders. The five main types—A, B, C, D, and E—differ in transmission routes and clinical outcomes. Preventive measures such as vaccination (for Hepatitis A and B) and safe practices are key.

Cirrhosis of the Liver

Cirrhosis is the irreversible scarring of the liver due to chronic damage. Clinical manifestations include ascites, jaundice, and weight gain. Management strategies include diuretics for fluid retention, beta-blockers for portal hypertension, and dietary modifications. Patients are also monitored for complications like variceal bleeding and hepatic encephalopathy.

Pancreatic Cancer

Pancreatic cancer carries a poor prognosis, with risk factors including chronic pancreatitis, smoking, and family history. Nursing care focuses on symptom control, pain management, and supporting nutritional needs.

Liver Cancer

Liver cancer often arises in the setting of chronic liver disease or hepatitis infection. Care involves monitoring for complications, assessing treatment eligibility, and providing holistic support to improve patient outcomes.

Tables

Table 1: Neurological Conditions

References

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.).

Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2022). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.

NR 325 Exam 2

Ignatavicius, D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.