Case Study, Chapter 60, Assessment of Neurologic
Function
1. Leah Smith, an 87-year-old patient, is at the clinic receiving an annual physical
checkup. The patient is wearing a sweater, but complains that the room is cold. The
thermostat reads 70°F. The patient has a slow, wide-based gait, and she is flexed
forward slightly when she walks. She opens her purse and tries to find the bottle of
herbals she bought to make sure it is alright to take the supplement and has
problems locating it by feeling for the bottle. She states that she is all thumbs. She
complains that food does not smell or taste like she remembered it smelling and
tasting 10 years ago. She wonders if it is because she used to grow her food and
that is why it had a better taste and smell. She also states that her family is
concerned because she does not seem to have enough peripheral vision to drive,
and she wiped out the mailbox yesterday when backing out of the driveway. The
nurse performs a neurologic examination. (Learning Outcome 4)
a. Explain the changes in the patient’s neurologic function that are related to
aging and what risks the patient has related to age-related changes.
a. Since the patient cannot taste or smell food, this is an effect of aging.
As you get older, your sense of taste and smell senses decline. The
patient is also experiencing peripheral vision loss. Common causes of
vision loss in older patients includes glaucoma, cataracts or macular
degeneration. The patient complains of being cold, this is because it is
more difficult for older patients to keep a body temperature in a
normal range. These changes can lead to risks involve not being able
to see while driving or getting around at home or they can’t smell if
there is a fire or gas leak.
b. Because age-related changes have an impact on the neurologic assessment,
for what additional areas should the nurse assess the patient, and what
findings reflect normal aging?
a. The nurse should assess physical health, cognitive abilities, living
conditions, mental and emotional health, memory and thinking skills.
Findings that reflect normal aging are, the wide-based gait, losing the
ability to smell and taste, mild forgetfulness, joints losing their
cartilage, muscular strength decline, and slower speed of speech.
c. What neurologic assessment findings do not change with aging?
a. Neurotransmitters, hormones and genetics are typically less affected
with age.
2. Rodney Carpenter, a 48-year-old patient, presents to the emergency department
with a possible cerebral aneurysm. The primary provider schedules a cerebral
angiography. The patient is anxious and is not sure why he needs this diagnostic
study. (Learning Outcome 5)
a. What is the purpose for the cerebral angiography?
, a. The cerebral angiography is an x-ray diagnostic test to see how blood
flows through the brain. A contrast agent is injected into a selected
artery to perform this test
b. What are critical nursing interventions for a patient undergoing a cerebral
angiography?
a. Nursing interventions include checking the patient’s blood urea
nitrogen and creatinine before the test to ensure the kidneys can
excrete the contrast. The patient should be well hydrated, void right
before the test, the patient should be still during the test and will feel a
brief feeling of warmth in the face, jaw or behind the eyes, in the teeth,
tongue or lips and a metallic taste in the mouth from the contrast.
Also, the patient should inform of any allergies especially to iodine or
shellfish. After the procedure, the patient should be observed for any
bleeding or hematomas.
Case Study, Chapter 61, Management of Patients
with Neurologic Dysfunction
1. Frank Smith is a 42-year-old patient diagnosed with pituitary prolactinoma, a
benign tumor that arises from the pituitary gland, resulting in a decrease in libido
and impotence and increased milk production of the breast. The patient also has
complaints of headache and drowsiness and the presence of visual field changes
and papilledema preoperatively. (Learning Outcome 4)
a. What postoperative care should the nurse provide the patient?
a. Postoperative care the nurse should provide includes monitoring vital
signs, assess pain, fluid and electrolyte balance, and perform a
neurological assessment and use the Glasgow Coma scale.
b. The patient’s family asks the nurse how will they know that the problems the
patient had before surgery have stopped; what is the nurse’s best response?
a. The nurse will tell the family that the recovery will take some time. The
patient’s hormone levels will improve over time as the patient’s body
will begin to adapt to the changes from the surgery. The nurse will
express importance of attending follow ups with the physician for a
successful recovery.
c. What management strategies should the nurse anticipate will be ordered to
care for diabetes insipidus if it occurs?
a. If it occurs, the nurse will assess urine analysis, intake and output,
asses blood levels, assess for decreased skin turgor and dry
membranes, monitor vitals, give fluids if ordered, and assess for
excessive and frequent urination.
d. What discharge instructions should the nurse provide the patient and family?
a. Discharge instructions include increasing fluid intake, teach family how
to assess patient’s mental status, check weight, follow up with
provider, and to ensure patient is taking their medications.
Function
1. Leah Smith, an 87-year-old patient, is at the clinic receiving an annual physical
checkup. The patient is wearing a sweater, but complains that the room is cold. The
thermostat reads 70°F. The patient has a slow, wide-based gait, and she is flexed
forward slightly when she walks. She opens her purse and tries to find the bottle of
herbals she bought to make sure it is alright to take the supplement and has
problems locating it by feeling for the bottle. She states that she is all thumbs. She
complains that food does not smell or taste like she remembered it smelling and
tasting 10 years ago. She wonders if it is because she used to grow her food and
that is why it had a better taste and smell. She also states that her family is
concerned because she does not seem to have enough peripheral vision to drive,
and she wiped out the mailbox yesterday when backing out of the driveway. The
nurse performs a neurologic examination. (Learning Outcome 4)
a. Explain the changes in the patient’s neurologic function that are related to
aging and what risks the patient has related to age-related changes.
a. Since the patient cannot taste or smell food, this is an effect of aging.
As you get older, your sense of taste and smell senses decline. The
patient is also experiencing peripheral vision loss. Common causes of
vision loss in older patients includes glaucoma, cataracts or macular
degeneration. The patient complains of being cold, this is because it is
more difficult for older patients to keep a body temperature in a
normal range. These changes can lead to risks involve not being able
to see while driving or getting around at home or they can’t smell if
there is a fire or gas leak.
b. Because age-related changes have an impact on the neurologic assessment,
for what additional areas should the nurse assess the patient, and what
findings reflect normal aging?
a. The nurse should assess physical health, cognitive abilities, living
conditions, mental and emotional health, memory and thinking skills.
Findings that reflect normal aging are, the wide-based gait, losing the
ability to smell and taste, mild forgetfulness, joints losing their
cartilage, muscular strength decline, and slower speed of speech.
c. What neurologic assessment findings do not change with aging?
a. Neurotransmitters, hormones and genetics are typically less affected
with age.
2. Rodney Carpenter, a 48-year-old patient, presents to the emergency department
with a possible cerebral aneurysm. The primary provider schedules a cerebral
angiography. The patient is anxious and is not sure why he needs this diagnostic
study. (Learning Outcome 5)
a. What is the purpose for the cerebral angiography?
, a. The cerebral angiography is an x-ray diagnostic test to see how blood
flows through the brain. A contrast agent is injected into a selected
artery to perform this test
b. What are critical nursing interventions for a patient undergoing a cerebral
angiography?
a. Nursing interventions include checking the patient’s blood urea
nitrogen and creatinine before the test to ensure the kidneys can
excrete the contrast. The patient should be well hydrated, void right
before the test, the patient should be still during the test and will feel a
brief feeling of warmth in the face, jaw or behind the eyes, in the teeth,
tongue or lips and a metallic taste in the mouth from the contrast.
Also, the patient should inform of any allergies especially to iodine or
shellfish. After the procedure, the patient should be observed for any
bleeding or hematomas.
Case Study, Chapter 61, Management of Patients
with Neurologic Dysfunction
1. Frank Smith is a 42-year-old patient diagnosed with pituitary prolactinoma, a
benign tumor that arises from the pituitary gland, resulting in a decrease in libido
and impotence and increased milk production of the breast. The patient also has
complaints of headache and drowsiness and the presence of visual field changes
and papilledema preoperatively. (Learning Outcome 4)
a. What postoperative care should the nurse provide the patient?
a. Postoperative care the nurse should provide includes monitoring vital
signs, assess pain, fluid and electrolyte balance, and perform a
neurological assessment and use the Glasgow Coma scale.
b. The patient’s family asks the nurse how will they know that the problems the
patient had before surgery have stopped; what is the nurse’s best response?
a. The nurse will tell the family that the recovery will take some time. The
patient’s hormone levels will improve over time as the patient’s body
will begin to adapt to the changes from the surgery. The nurse will
express importance of attending follow ups with the physician for a
successful recovery.
c. What management strategies should the nurse anticipate will be ordered to
care for diabetes insipidus if it occurs?
a. If it occurs, the nurse will assess urine analysis, intake and output,
asses blood levels, assess for decreased skin turgor and dry
membranes, monitor vitals, give fluids if ordered, and assess for
excessive and frequent urination.
d. What discharge instructions should the nurse provide the patient and family?
a. Discharge instructions include increasing fluid intake, teach family how
to assess patient’s mental status, check weight, follow up with
provider, and to ensure patient is taking their medications.
