[2] NEURO (Part 2)

Spinal Cord Injuries (SCI)

These are injuries to the spinal cord, vertebral column or intervertebral disc

A. Diaphragmatic movement and breathing

A client has an injury at C4. Which function is expected to be impaired?

A. Diaphragmatic movement and breathing

B. Bowel and bladder control

C. Hand grasp and wrist extension

D. Ambulation with long leg braces

Lumbar area

This area of spina cord innervates the bladder or legs

Answer: Cervical region

If a patient has quadriplegia/tetraplegia, which part of the spinal cord is affected?

Answer: C3–C5

If a patient has loss of diaphragmatic control, which level is injured?

abdominal

_______ muscle is essential for coughing reflex

Thoracic

This area of the spinal cord innervates abdominal and bowel movements

paralytic ileus

No bowel movement is also called ______

diaphragm and arms

The cervical area of the spinal cord innervates the ______ and the _______.

B. Respiratory paralysis

Rationale: The cervical level (especially C3–C5) innervates the diaphragm via the phrenic nerve. Damage can lead to respiratory failure/paralysis, which is life-threatening. Loss of bowel/bladder (A) is seen in thoracic/lumbar injury. Paraplegia (C) results from thoracic/lumbar injury. Abdominal muscle loss (D) is thoracic.

A client sustained a cervical spinal cord injury at C4. Which of the following complications is the nurse most concerned about?

A. Loss of bowel and bladder control

B. Respiratory paralysis

C. Paraplegia

D. Loss of abdominal muscle function

Answer: C. Loss of abdominal muscle control and bowel dysfunction

Rationale: Thoracic SCI affects abdominal muscles and bowel motility. Quadriplegia (A) is seen in cervical injuries. Respiratory paralysis (B) occurs in high cervical injuries. Arm paralysis (D) is cervical.

A nurse is caring for a patient with a thoracic spinal cord injury. Which assessment finding is expected?

A. Quadriplegia

B. Respiratory muscle paralysis

C. Loss of abdominal muscle control and bowel dysfunction

D. Flaccid paralysis of arms

1. x-ray

2. CT scan

• CT Scan and X-ray are the primary tools for detecting skeletal injuries such as fractures or dislocations of the vertebral column.

• MRI is preferred when assessing soft tissue and spinal cord damage.

• EEG checks brain electrical activity (not spinal injury).

• EMG evaluates muscle/nerve function, not bone integrity.

• Lumbar puncture is for CSF analysis (e.g., meningitis, bleeding), not skeletal injury

These tests are utilize to diagnose if there is a skeletal injury in the back bone of the patient

prevent further injury

The general concept of emergency management for spinal cord injury is to “________.”

Answer: Spine board

A patient with suspected SCI must be immobilized on a flat, firm surface such as a ________.

Answer: Head, Neck

When immobilizing a patient with SCI, the ________ and ________ should be maintained in a neutral position.

Neutral

During transport of an SCI patient, the nurse should maintain the body in an ________ position.

Answer: Unit; realign

In SCI management, the patient should be transported as a ________ and the nurse should not attempt to ________ body parts.

Answer: False (This causes misalignment of the spine)

TRUE or FALSE: Placing a pillow under the head is recommended to keep the patient comfortable during SCI transport.

Meningitis

This is called the inflammation of the meninges

Streptococcus pneumoniae and Neisseria meningitis

Most common causative agent of meningitis

Answer: Blood-brain barrier (BBB)

In meningitis pathophysiology, the organism first crosses the ________ before reaching the cerebrospinal fluid.

Answer: Subarachnoid

The space between the arachnoid mater and the pia mater, where CSF circulates, is called the ________ space.

1. Fever and Headache

2. Altered level of Consciousness

3. Nuchal Rigidity

The classic triad of meningitis consists of:

headache and fever

Initial manifestations of meningitis

Kernig’s

________ sign is positive when pain and resistance occur upon flexion of the hip and knee, followed by extension of the leg.

neck

Brudzinski’s sign is positive when passive flexion of the ________ causes involuntary flexion of the hips and knees.

Answer: Meningeal irritation (Meningitis)

Both Kernig’s and Brudzinski’s signs are used to assess for ________.

supine

In Kernig’s sign, the patient is positioned ________ during the assessment.

Brudzinski’s

_______ sign is more sensitive indicator in assessing meningitis

Tic Douloureux

Trigeminal Neuralgia is most commonly known as ______

unknown

The cause of Trigeminal Neuralgia is _______

pain

The primary symptom of patient with trigeminal neuralgia is _____

Answer: Electric shock (or stabbing)

The hallmark symptom of trigeminal neuralgia is sudden, severe, ________-like facial pain.

painful twitching

Trigeminal Neuralgia’s presentation is p______ t_______.

Answer: Carbamazepine

The drug of choice for trigeminal neuralgia is the anticonvulsant ________.

Answer: Room (lukewarm/neutral)

During meals, patients with trigeminal neuralgia should eat soft foods at ________ temperature.

Answer: Lukewarm water

The nurse should advise the patient with Trigeminal Neuralgia to wash the face with ________ instead of cold water to avoid triggering pain.

Answer: Rhizotomy

If pharmacologic management for patient with Trigeminal Neuralgia fails, a surgical procedure that destroys part of the trigeminal nerve is called ________.

Bell’s Palsy

This condition involves facial paralysis

Answer: VII (Facial nerve)

Bell’s palsy is paralysis of the muscles innervated by cranial nerve number ________.

True

TRUE or FALSE: Bell’s palsy is caused by inflammation of the facial nerve, often linked to viral infections such as herpes simplex.

Answer: painful twitching; paralysis

The hallmark symptom of trigeminal neuralgia is facial ______, while the hallmark symptom of Bell’s palsy is unilateral facial ______.

TRUE

TRUE or FALSE: Neurodegenerative disorders involve permanent and irreversible damage

Parkinson’s Disease

This is a slow progressing neurologic movement disorder

Answer: Dopamine

Parkinson’s disease is caused by the degeneration of ______-producing neurons in the brain.

Substantia Nigra

The main problem in Parkinson’s Disease is the destruction of _____ which releases dopamine

1. Tremors

2. Rigidity

3. Akinesia/Bradykinesia

4. Postural Instability

Four Cardinal Signs of Parkinson’s Disease (TRAP)

Tremors

Earliest sign of Parkinson’s Disease

Answer: Levodopa (often combined with Carbidopa)

The most common drug used in Parkinson’s disease that is converted into dopamine in the brain is ______.

Answer: Shuffling gait

The typical Parkinson’s gait characterized by short, sliding steps is called ______ gait.

Answer: Propulsive gait

The ______ gait in Parkinson’s disease is associated with a stooped posture, making the patient look like they are falling forward.

Answer: Festinating gait

The ______ gait occurs when the patient involuntarily speeds up while walking and leans forward.

2 or more of the cardinal manifestation

Parkinson’s Disease is clinically diagnosed if __________ is present

Levodopa

A positive response to the medication ______ is often used as confirmatory diagnosis of Parkinson’s disease.

Carbidopa

This medication prevents breakdown of levodopa in the bloodstream

Multiple Sclerosis (MS)

This condition is characterized by the irreversible demyelinating disease of CNS

A. Diplopia

A nurse suspects MS in a patient who reports visual changes, muscle weakness, and problems with coordination. Which early visual symptom is MOST common?

A. Diplopia

B. Photophobia

C. Conjunctivitis

D. Ptosis

C. Exposure to heat and infection

The nurse is teaching a client with MS about factors that may trigger exacerbations. Which of the following should the nurse emphasize to avoid?

A. Cold environments

B. Increased sodium intake

C. Exposure to heat and infection

D. Low-fat diet

Charcot’s Triad

The pathognomonic sign of Multiple Sclerosis is also called _______

1. Scanning Speech

2. Intention Tremors

3. Nystagmus

Charcot’s triad in multiple sclerosis is composed of three pathognomonic sign (SIN) which are:

warm compress

A nurse is caring for a patient with multiple sclerosis who experiences spasticity. What is the most appropriate nursing management to minimize spasticity?

Guillain–Barré Syndrome

This is the autoimmune demyelination of the PNS

ascending (Galing-Baba-Syndrome)

The hallmark of Guillain–Barré Syndrome is progressive ______ paralysis.

False

Rationale:

• GBS is usually an acute, reversible condition.

• With proper management (IVIG, plasmapheresis, respiratory support, rehab), most patients recover fully or with minimal residual weakness.

• Unlike Multiple Sclerosis (MS) or Amyotrophic Lateral Sclerosis (ALS), GBS does not cause permanent, progressive degeneration.

TRUE or FALSE: GBS is an irreversible disease

Viral infection

Antecedent event of Guillain–Barré Syndrome:

ascending paralysis

Pathognomonic sign of GBS

Neuromuscular Respiratory Failure

Most dangerous result of GBS which is why it is considered a medical emergency

Answer: False – Elective intubation is done before complete failure to prevent emergency intubation.

In Guillain–Barré Syndrome, elective intubation is performed once respiratory muscles are paralyzed and the patient is in respiratory arrest.

Myasthenia Gravis (MG)

This is an autoimmune disorder affecting the myoneural junction.

Answer: Anticholinesterase drugs (e.g., pyridostigmine) and Immunosuppressants (e.g., corticosteroids).

The two main medications used in the management of Myasthenia Gravis are ______ and ______.

Answer: Ptosis

A classic early sign of Myasthenia Gravis is drooping of the eyelids, also known as ______.

A. Myasthenic Crisis

During a Tensilon test, the patient’s muscle strength improves dramatically. This indicates:

A. Myasthenic Crisis

B. Cholinergic Crisis

C. Either one

D. Normal finding

B. Cholinergic Crisis

A nurse notes that a patient with MG has excessive salivation, diarrhea, and bradycardia after taking pyridostigmine. This is most likely:

A. Myasthenic Crisis

B. Cholinergic Crisis

B. An autoimmune destruction of acetylcholine receptors at the neuromuscular junction

Myasthenia gravis is primarily caused by:

A. A deficiency of dopamine in the brain

B. An autoimmune destruction of acetylcholine receptors at the neuromuscular junction

C. A lack of acetylcholine release from presynaptic neurons

D. Degeneration of motor neurons in the spinal cord

Answer: C. Ptosis and diplopia

What is usually the first clinical manifestation of Myasthenia Gravis?

A. Limb weakness

B. Respiratory distress

C. Ptosis and diplopia

D. Dysphagia

Answer: ocular; facial/bulbar; respiratory

The clinical progression of MG often begins with ______ involvement, followed by ______ weakness, then generalized weakness, and finally ______ compromise.

Edrophonium chloride (Tensilon)

Generic name of Tensilon in Tensilon Test

Atropine

This is the antidote for cholinergic crisis

Pyridostigmine bromide (Mestinon) and Neostigmin (Prostigmin)

First line of therapy for Myasthenia Gravis which inhibit breakdown of acetylcholine

1. Teaching focuses on strategies to conserve energy

2. Minimize risk of aspiration

3. Eye problems

Focus of nursing management for patients with Myasthenia Gravis

90 mins

Pyridostigmine bromide (Mestinon) and Neostigmin (Prostigmin)’s peak effect is ______ mins after administration.