NUR 255 EXAM 4 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Age related changes to the Nervous System.
Physiologic Changes
Nursing implications
Slower processing time.
Provide adequate time to read questions.
Recent memory loss.
Repetitions, written reminders, and use alarms.
Decreased sensory perception.
Watch where putting feet; wear good shoes. Change positions often.
Change in pain perception.
Ask patient to describe nature and characteristics of pain.
Change in sleep patterns.
Fall asleep earlier, wake earlier; more wakefulness at night.
Altered balance/decrease in coordination.
Advise patient to move slowly; use handrails; assess the need for ambulatory aides.
What is a seizure?
Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the
brain that may result in a change in level of consciousness, motor or sensory ability,
and/or behavior.
,What is a generalized seizure?
May occur in adults and involve both cerebral hemispheres.
What is a tonic seizure?
An abrupt increase in muscle tone, loss of consciousness, and autonomic changes
lasting from 30 seconds to several minutes.
What is a clonic seizure?
Last several minutes and causes muscle contraction and relaxation.
What is tonic-clonic seizure?
It lasts from 2 to 5 minutes begins with tonic phase that causes stiffening or rigidity of
the muscles, particulaly of the arms and legs, and immediate loss of consciousness.
Clonic or rhythmic jerking of all extremities follows.
What is a partial seizure?
Also called focal or local seizures, begin in a part of one cerebral hemisphere.
What is a complex partial seizure?
They may cause loss of consciousness (syncope), or "black out", for 1 to 3 minutes. In
the period after the seizure, he or she may have amnesia.
What is simple partial seizure?
They remain conscious throughout the episode. They often report an aura (unusual
sensation) before the seizure takes place.
What is unclassified, or idiopathic seizures?
They account for about half of all seizure activity. They occur for no known reason and
don't fit into the generalized or partial classification.
What are some seizure risks?
,Metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, heart disease,
high fever, stroke, and substance abuse.
How do you assess seizures?
How many? How long? Any pattern? Describe the seizure. Any auras? Medications?
Herbs? Drugs/alcohol? High fever? Medical conditions? Then do typical diagnostic tests
such as; EEG, CT, MRI, and PET to rule out other conditions before diagnosing.
What you need to know about drug therapy?
Evaluate most acurrent blood level of medicationm if appropriate. Be aware of drug-
drug/drug-food interactions. Maintain therapeutic blood levels for maximal effectiveness.
Don't administer warfarin with phenytoin. Document and report side/adverse effects.
What do you need to know about phenytoin?
Reduces voltage frequency and spread of electrical discharge. Watch for gingival
hyperplasia and bradycardia.
What do you need to know about carbamazepine?
Reduces synaptic reaction. Watch for visual problems ataxia and vertigo.
What do you need to know about valproic acid?
Blocks sodium and calcium channels to prevent neuron firing. Watch for GI upset and
hepatoxicity.
What are seizure precautions?
Oxygen, suction equipment, airway, IV access, and side rails up and padded.
What is 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.
, What is acute seizure management?
Medication depends on type of seizure. Medication for tonic-clonic seizure activity may
include: lorazepam, diazepam, and IV phenytoin or fosphenytoin.
What is status epilepticus?
Prolonged seizures that last more than 5 min. or repeated seizures over course of 30
min. It is an medical emergency!
What do you do for status epilepticus?
Establish airway, ABGs, IV push lorazepam, diazepam or rectal diazepam, and loading
dose IV phenytoin.
What is patient and family education for seizures?
Complience with AEDs, social service resources to assist with medication cost,
evaluation of employment safety needed to decrease risks, and vocational rehabilitation
may be subsidized.
What is the surgical management for seizures?
Vagal nerve stimulation, conventional surgical procedures, anterior temporal lobe
resection, and partial corpus callosotomy.
Considerations for older adults.
Complex partial seizures are most common among older adults. These seizures are
difficult to diagnose because symptoms appear similar to dementia, psychosis, or other
neurobehavioral disorders, especially in the postictal stage (after the seizure). New-
onset seizures in older adults are typically associated with conditions such as
hypertension, cardiac disease, diabetes mellitus, stroke, dementia, and recent brain
injury.
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Age related changes to the Nervous System.
Physiologic Changes
Nursing implications
Slower processing time.
Provide adequate time to read questions.
Recent memory loss.
Repetitions, written reminders, and use alarms.
Decreased sensory perception.
Watch where putting feet; wear good shoes. Change positions often.
Change in pain perception.
Ask patient to describe nature and characteristics of pain.
Change in sleep patterns.
Fall asleep earlier, wake earlier; more wakefulness at night.
Altered balance/decrease in coordination.
Advise patient to move slowly; use handrails; assess the need for ambulatory aides.
What is a seizure?
Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the
brain that may result in a change in level of consciousness, motor or sensory ability,
and/or behavior.
,What is a generalized seizure?
May occur in adults and involve both cerebral hemispheres.
What is a tonic seizure?
An abrupt increase in muscle tone, loss of consciousness, and autonomic changes
lasting from 30 seconds to several minutes.
What is a clonic seizure?
Last several minutes and causes muscle contraction and relaxation.
What is tonic-clonic seizure?
It lasts from 2 to 5 minutes begins with tonic phase that causes stiffening or rigidity of
the muscles, particulaly of the arms and legs, and immediate loss of consciousness.
Clonic or rhythmic jerking of all extremities follows.
What is a partial seizure?
Also called focal or local seizures, begin in a part of one cerebral hemisphere.
What is a complex partial seizure?
They may cause loss of consciousness (syncope), or "black out", for 1 to 3 minutes. In
the period after the seizure, he or she may have amnesia.
What is simple partial seizure?
They remain conscious throughout the episode. They often report an aura (unusual
sensation) before the seizure takes place.
What is unclassified, or idiopathic seizures?
They account for about half of all seizure activity. They occur for no known reason and
don't fit into the generalized or partial classification.
What are some seizure risks?
,Metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, heart disease,
high fever, stroke, and substance abuse.
How do you assess seizures?
How many? How long? Any pattern? Describe the seizure. Any auras? Medications?
Herbs? Drugs/alcohol? High fever? Medical conditions? Then do typical diagnostic tests
such as; EEG, CT, MRI, and PET to rule out other conditions before diagnosing.
What you need to know about drug therapy?
Evaluate most acurrent blood level of medicationm if appropriate. Be aware of drug-
drug/drug-food interactions. Maintain therapeutic blood levels for maximal effectiveness.
Don't administer warfarin with phenytoin. Document and report side/adverse effects.
What do you need to know about phenytoin?
Reduces voltage frequency and spread of electrical discharge. Watch for gingival
hyperplasia and bradycardia.
What do you need to know about carbamazepine?
Reduces synaptic reaction. Watch for visual problems ataxia and vertigo.
What do you need to know about valproic acid?
Blocks sodium and calcium channels to prevent neuron firing. Watch for GI upset and
hepatoxicity.
What are seizure precautions?
Oxygen, suction equipment, airway, IV access, and side rails up and padded.
What is 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.
, What is acute seizure management?
Medication depends on type of seizure. Medication for tonic-clonic seizure activity may
include: lorazepam, diazepam, and IV phenytoin or fosphenytoin.
What is status epilepticus?
Prolonged seizures that last more than 5 min. or repeated seizures over course of 30
min. It is an medical emergency!
What do you do for status epilepticus?
Establish airway, ABGs, IV push lorazepam, diazepam or rectal diazepam, and loading
dose IV phenytoin.
What is patient and family education for seizures?
Complience with AEDs, social service resources to assist with medication cost,
evaluation of employment safety needed to decrease risks, and vocational rehabilitation
may be subsidized.
What is the surgical management for seizures?
Vagal nerve stimulation, conventional surgical procedures, anterior temporal lobe
resection, and partial corpus callosotomy.
Considerations for older adults.
Complex partial seizures are most common among older adults. These seizures are
difficult to diagnose because symptoms appear similar to dementia, psychosis, or other
neurobehavioral disorders, especially in the postictal stage (after the seizure). New-
onset seizures in older adults are typically associated with conditions such as
hypertension, cardiac disease, diabetes mellitus, stroke, dementia, and recent brain
injury.
