Diabetes, Neurological Disorders, and Seizures: Nursing Interventions and Patient Care, Exams of Advanced Education

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HONDROS NUR 176 EXAM 1 NEW WRITTEN

SOLUTION 2023

Interventions to prevent diabetes - Maintain healthy weight, diet and exercise Signs of type 1 diabetes - 3 polys, blurred vision, cold feet, numbness, shiny thin skin w/ no hair, age 30 and under, sudden onset, underweight, Signs of type 2 diabetes - No symptoms at first , later develop the 3 polys, obesity, Nigricans (black line on back of neck) skin tags S/S of hypoglycemia - Fatigue, weakness, irritability, reduce cognition, tremors, seizures, diaphoresis( sweating) S/S of hyperglycemia - 3 polys, fruity breath S/S of diabetic ketoacidosis and treatment - High BS, high HR, restlessness, weight loss, fruity breath, kussmaul(fast deep RR) -- treatments; IV regular insulin First intervention if a pt. Presents with s/s of hypo/hyperglycemia - Check blood sugar Prevention of long term complications of diabetes - Takes meds, daily feet care, yearly renal test, eye exams every 6 months, LDL less than 150 Dietary teaching for a diabetic patient - Meals at the same time every day, decrease saturated fats, increase exercise , refer pt. To MyPlate learning tool, Diabetic Pt. should never increase carbs unless... - Sugar is low before exercising Discharge teaching for diabetic pt. - Know hypo/hyperglycemia s/s, know that stress and illness increase BS , see a diabetic educator, know what the effect of Exercise can have on Bs Diabetic foot care - Clean w/ soap and warm water, clean socks everyday, cut toe nails straight across, keep feet dry, no powder or lotion b/t toes , wear shoes , inspect feet daily, no gardners Lipid analysis - LDL-less than 100 HDL- more than 40 Triglycerides- more than 150 What are low and high levels of HDL indicative of - High- insulin resistance, low- insulin sensitivity What insulins can not be mixed? - Levemir and Lantus ( detemir and glargine )

How to mix insulin - Short acting to long acting, regular to NPH, Clear to cloudy Should a nurse hold a patients insulin before consulting a dr? - No No insulin, beta cells are destroyed is a result of? - Diabetes type 1 Beta cells exhaustion , insulin resistance is a result of? - Diabetes type 2 Rapid acting insulin - Lispro(Humalog) aspart(Novolog) glulisine(Apidra) Onset, peak and duration of Novolog and Apidra - Onset- 15 - 30, Peak- 1 - 3hr, duration- 3 - 5hr onset, peak and duration of humalog - Onset- 15 - 30, Peak- 1 - 2hr, duration- 3 - 4hr Short acting insulin( regular) - Humulin R, Novolin R, ReliOn R, Onset- 30 - 60 , Peak- 2 - 4hr, duration- 6 - 8hr Intermediate insulin (NPH) - Humulin N, Novolin N, ReliOn N, Onset- 1 - 4hr Peak- 4 - 12hr, duration- 12 - 16hr Long acting insulin - Lantus and levemir Onset- 1 - 2hr, Peak- none, duration-24hr Which insulin is the only one that can be given through IV? - Regular What is glucagon used for? - Makes glucose. Received if BS is low If a pt. Is lethargic, what form of glucose should be administered? - Glucagon gel in cheek What is Lipohypotrophy and the prevention? - Lump under subcut tissue due to repeated injections at the same site. Rotate sites S/s of brain tumor - Vision changes, confusion and headache S/S of traumatic brain injury - Blurred vision, personality changes, altered level of consciousness, slurred speech, confusion, headache, uncoordinated, weakness / numbness of legs and arms If someone hit their head, which test should be completed? - CT scan to make sure there's no head bleeding Early signs of IICP - Altered levels of consciousness Nursing interventions for mannitol & lasix - Monitor I&O and electrolytes

Nursing interventions for prednisone - Monitor blood glucose and daily weight Glasgow coma scale measures .. - Eye opening, verbal and motor response. A score less than 8 is considered in a coma S/S of Ischemic strokes - 80% have these, trouble talking, Face droop? Arm drift, Slurred speech S/S of hemorrhagic stroke - Serve headache, aneurysm rupture from hypertension , *never administer TPA for these strokes What is Aphasia - Trouble speaking, expressive, receptive and global Dysphagia precautions - No straws , thicken liquids, Steps before administering TPA - Do CT scan to verify Ischemic stroke, neurological assessment, make sure they aren't on blood thinners, history of blood disorders Side effects of Lovenox (enoxaparin) - Bruising at injection site, dark loose stools , GI bleeding Is Delirium a disease of the CNS? - No S/S of early stage dementia - Gradual onset of memory loss, difficulty focusing attention, depression Main goal for dementia patients - Maintain self care abilities and prevent injuries Nursing interventions for dementia patients - Large clock and calendar, decreased distractions during meals, decreased stimuli, monitor weight How many pain assess menus are done for pt with dementia? - 2 Interventions for an agitated dementia pt. - Move pt. To a calm environment Reality orientation for dementia pts - Be honest, call by preferred name, eye contact, set a routine , simple tasks and directions, familiar objects Safety interventions in the Alzheimer's pt. - Calm environment, encourage supervision, allow social and physical activity Med for multiple sclerosis - Copaxone Generalized tonic-clonic seizures (grand mal) - Most common, stiffening of body for 10-20 sec. then jerking extremities for another 30-40 secs

Absence seizures ( petit mal) - Occurs during childhood, stares off with little to no tonic-clonic movement Psychomotor (partial seizures) - Occurs at any age, pt. Behaves in a drunk manner, doesn't remember Jacksonian-focal seizures ( local or partial) - Occur in pts. With structural brain disease, starts in the hands or feet, can turn into tonic-clonic Myoclonic seizures - Sudden jerking of body Akinetic seizures - Not common, falls in flaccid state, unconscious for 1 or 2 minutes What med will a pt get with new onset seizures? - Broad spectrum anti-seizure med Pt education related to seizures - Keep long and recorded time and duration, any drowsiness , nausea and vomiting. Discharge education for a pt taking Dilantin - Mouth care, avoid alcohol, no driving, use soft tooth brush Seizure disorder interventions - Stay with them while they seize, lower them to floor, observe and record, keep them safe, don't force mouth open , turn on side if excessive sputum accumulates What should be determined when assessing meningitis? - Viral or bacterial, the specific organism that caused it Bacterial meningitis labs - Increase protein, increase WBC , decrease glucose Isolation for meningitis - Respiratory droplet, 24 hour isolation after first treatment Age of onset for type 1 diabetes - 30 years or younger Age of onset for type 2 diabetes - 35 years or older but increasing in children Hyperglycemia Blood glucose levels - Higher than 100-140mg/dl Hypoglycemia blood glucose levels - Less than 70mg/dl Euglycemia blood glucose level ( normal) - 70 - 100mg/dl

Level of Consciousness oriented to - 1. Person 2. Person and Place 3. Person Place and Time. 4. Person Place Time and Purpose S/S Intracranial Pressure - Increase in systolic b/p widening pulse pressure, bradycardia, irregular breathing pattern page 302 (cooper) Insulin - Peptide hormone commonly absorb into patients blood stream. Given subcutaneously. (Also IV mixed with NS) When giving Insulin be careful to only inject into - Subcutaneous tissue (between fat and muscle layer) page 1758 (cooper) Intractable - Pain that is described as unbearable and does not respond to treatment. Diplopia - Double vision NIHSS - Stroke scale Characteristics of Parkinson's Disease - Blank facial expression, Forward tilt to posture, slow monotonous slurred speech, tremor, short shuffle gait Ischemic Stroke - Deficient blood flow to the brain from a partial or complete occlusion of an artery. Either thrombotic or embolic account for 90% of all strokes (cooper 1938) Postictal Period - Rest period of a seizures varies in length Epilepsy - Chronic two or more unprovoked seizures Seizure - A disorder in which nerve cell activity in the brain is disturbed, causing seizures. What is the action of glucagon? - Increases blood sugar (blood glucose) What does the nurse record after a seizure? - Duration and time, degree of drowsiness afterward, SE of N/V Can we restrain a pt having a seizure? - No Can we place something in a pt's mouth to protect their airway? - No Phenytoin and pt teaching? - Avoid alcohol, good oral hygiene, may have driving restrictions, pt needs to take meds even when seizures stop Why is it important to find pathogen that caused Meningitis? - So it can be treated properly

meningitis - Inflammation of brain and spinal cord membranes, typically caused by an infection. What test is usually done to determine the type of organism in Meningitis? - Lumbar puncture Pt teaching about Meningitis? - Vaccinations are important; bacterial treated with antibiotics, viral treated with comfort measures If there is suspected bacterial meningitis? - Respiratory isolation (droplet) until antibiotic runs for 24 hours Alzheimer's pt and safety - Offer social or physical activity as distraction, encourage family and staff supervision, do Not restrain - physically or chemically, maintain calm environment Dementia pt and reality orientation - Wall clock and calendar, do not overstimulate, decrees distraction during meals, do NOT put up rails as restraints, monitor weight for changes What do we monitor while pt on Mannitol (osmitrol)? - I/O electrolytes What do we monitor for Dexamethasone and Prednisone? - Monitor daily weight If pt complains of nausea and diarrhea while on glucaphage? (Metformin) - Notify doctor. What are early signs of dementia? - Gradual onset of memory loss, difficulty focusing attention What to check for after a fall? - CT scan to be sure there is no bleeding. Vitals, head to to asses. Chart event what you seen. Guidelines for reality orientation - Call pt by correct name or what they want to be called. Make eye contact. Converse about familiar subjects. Provide familiar objects in the environment. Be honest. Set a routine and be contestant.. Engage in familiar activities that have purpose. Huntington Diseases - inherited disease that causes certain nerve cells in the brain to waste away. People are born with the defective gene, but symptoms usually don't appear until middle age. Akinesia - Abnormal state of motor and psychic activity The nurse is assisting in implementing care plan for a patient with dementia. Which interventions would you expect to see? - Keep a large clock and calendar in view, reduce distractions during meal times, reduce exposure to over-stimulating situations, and monitor weight regularly for changes. Which of the following indicates that teaching on meningitis is understood? - It is important that we vaccinate our son at the proper times, meningitis is contagious if exposed to the bodily

fluids from another infected child, and if our child contracts bacterial meningitis, he will need antibiotic treatment immediately. The nurse is caring for a patient with alzheimer's who is stumbling in the hall frequently. The nurse will do which of the following to protect the client? - Offer social or physical activity to promote safety, encourage staff or family supervision for safety, and maintain a calm environment for the patient. The LPN is preparing to DC a patient with Type 1 Diabetes. What teaching should the LPN provide? - Effects of illness and stress on the glucose level, S&S of hypoglycemia, and effects of exercise on the glucose level Your patient is experiencing a new onset myoclonic (muscle-jerking) seizures. The nurse knows which one of the following statements are true about the seizure characteristics? - Sudden excessive jerking of the body or extremities. The nurse is caring for a patient with type II Diabetes. Which statement would indicate a need for further assessment by the nurse? - I mix my glargine insulin with my Humalog, I am on prednisone for poison ivy, and I have dry skin on my heel that keeps cracking. Patient in ER with symptoms of a stroke. The nurse knows prompt medication attention is needed within 3 hours to reduce permanent disability or death. Which interventions would nurse anticipate for patient? - Administering tissue plasminogen activator (TPA), CT scan or MRI to rule out hemorrhagic stroke, Neuro assessment using NIH stroke scale, and Review any history of bleeding disorders. Nurse is caring for patient recently dx with seizures and prescribed phenytoin (Dilantin). What education should we include? - Patient should avoid alcohol when taking seizure meds, patient should be encouraged to do good oral hygiene, explain the need to continue medication even when seizures stop, explain that the patient may have driving restrictions. When assessing for meningitis or encephalitis, the nurse is aware which of the following statements is true? - Determining organism specific cause of the condition Patient with new dx of seizures, nurse will instruct patient to keep a log of which of the following? - Time and duration of seizures, degree of drowsiness after seizures, and any side effects of nausea and emesis. Nurse caring for patient with suspected early dementia. What S&S will the nurse assess the patient for? - Gradual onset of memory loss, difficulty focusing attention, and difficulty finding the right words. Patient received 20 units of Novalog sub-q at 0800. What time should the nurse assess for hypoglycemic reaction - 1000

Nurse caring for patient with elevated ICP recently dx with a brain tumor. Using Tanner's model, which question should the nurse ask? - Have you experienced any vision changes? Patient receives 25 units of Lantus at 2100. What time would the LPN expect to see it start working? - 2200 LPN caring for patient who had a stroke 5 days ago. Pt. is nonverbal and does not appear to have understanding of instructions given. What will nurse suspect? - Aphasia When providing care for patient with dementia, what is the priority goal to help the client? - Maintain maximum self-care and prevent injuries. Patient has type II diabetes. Nurse is administering Lantus and regular insulin. How will the nurse administer it? - Administer separately in two different syringes. The nurse is administering Decadron 60 mg PO to a patient admitted for cerebral edema. What should the nurse monitor for this patient? - Daily weights Nurse is caring for patient with Type II Diabetes prescribed prednisone (Deltasone for bronchitis. What is the included teaching? - Increase insulin per sliding scale due to effect of hyperglycemia. Nurse teaching patient with newly dx diabetes on how to prevent lipodystrophy. Which indicates understanding of proper prevention? - I will rotate my injection sites. Diabetic Type II in the ER lethargic and responding only to pain. What should the nurse do next?

• Give glucagon gel between cheeks and gums. Nurse is caring for a patient in the ER who has rapid onset tachycardia, restlessness, polyphasia, and a 10 lb weight loss in the last month. Labs are glucose-472, LDL 200, and GAD positive. What intervention should nurse plan to do? - Inject insulin Newly dx pt. with diabetes instructed to obtain glucagon for emergency home use. He asks what the purpose is. Nurse's response should be? - It is for the times when your blood glucose is too low from too much insulin. Nurse is caring for patient with diabetes type II who has lab results for HDL of 29 and triglycerides of 260. The nurse knows the Dr. will further assess for what? - Insulin resistance. The nurse is administering medication to a client with new onset seizures. Client and family teaching will include which of the following? - Initially, a single broad spectrum antiseizure medication will be used.

Seizures precautions - Maintain airway. No tongue blade. turn head to side. suction equipment at bedside padded side rails fall mat lose clothing med alert bracelet hemianopia - blindness over half the field of vision. Left side stroke - speech language Right side stroke - movement and sensations Aspiration Precautions - 1. Aggressive oral care before and after meals.

2. Sit up at 90 degree angle in bed or chair for meals, or follow specific positioning guidelines per the Speech-Language Pathologist. Stay up 30 minutes after meal. Then 45 degree angle at all times.
3. Set-up suction in the patient's room
4. Monitor lung sounds and temps, especially after meals.
5. Monitor intake and offer supplements or between meal snacks as needed. hemiparesis - unilateral paresis, is weakness of one entire side of the body Donepezil (Aricept) - used to treat mild to moderate dementia caused by Alzheimer's disease. improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine. Dilantatin (phenytoin) - is an anti-epileptic drug, also called an anticonvulsant Tegretol (carbamazepine) - anticonvulsant. used to treat certain types of seizures (partial, tonic- clonic, mixed). Tegretol is also used to treat nerve pain such as trigeminal neuralgia and glossopharyngeal neuralgia.... Depakene ( valproic acid, Depakene) - treatment of patients with complex partial seizures .Liver failure and death from liver failure has occurred in patients taking Depakene Ativan (lorazepam) - is used to treat anxiety disorders. Valium (diazepam) - used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Valium is sometimes used with other medications to treat seizures Acyclovir (Sitavig, Zovirax) - Acyclovir is an antiviral drug. It slows the growth and spread of the herpes virus in the body. It will not cure herpes, but it can lessen the symptoms of the infection. Fastening blood glucose level - Below 100 subdural hematoma - collection of blood under the dura mater. may be classified as acute subacute or chronic.

Battles sign - bruising behind the ears, indicative of a basilar skull fracture would you give codenie to a patient with ICP? - No. give nothing that would deress the respiratory system. With ICP mannitol and dexametheasone is given. Patient with head trauma experiencing drainage do you clean orifices? - No. don't clean blood and serous drainage instruct patient to not cough, sneeze, or blow the nose Kernig's Sign - person lie flat on the back, flex the thigh so that it is at a right angle to the trunk, and completely extend the leg at the knee joint. If the leg cannot be completely extended due to pain A sign indicating the presence of meningitis Brudzinski's Sign - Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. Patient ICP has increased and ordered a lumbar puncture to diagnosis meningitis would puncture be preformed? - No. Page 1947 Copper encephalitis - inflammation of the brain tissue. What neurotransmitter primarily affects motor function and is involved in gross subconscious movements of the skeletal muscles? - Dopamine The nurse is caring for a patient who is being evaluated for a neurologic disorder. She is not able to comprehend the written or spoken word. Which term would the nurse use to document this problem? - Global aphasia (Global aphasia is the inability to understand the spoken word or to speak) The nurse will implement which of these nursing interventions for the patient with increased intracranial pressure? - Teach patient to avoid Valsalva maneuver. Position patient to avoid flexion of hips, waist, and neck. Suction only as necessary, but no longer than 10 seconds. Place neck in neutral position. Page 1915 Two vaccines for meningitis for children - meingoccal polysaccharide (Menomune) and quadrivlant menigococcal conjugate (Menactra) Dysarthria - often is characterized by slurred or slow speech that can be difficult to understand. Common causes of dysarthria include nervous system (neurological) disorders such as stroke, brain injury, brain tumors, and conditions that cause facial paralysis or tongue or throat muscle weakness.