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NUR 141 EXAM 3
| Question | Answer |
|---|---|
| for intestinal disorders you need to interrupt one of the following... | digestion, secretion, absorption, motility (segmentation (mixing), peristalsis (propulsion)), elimination |
| intestinal disorders occur d/t | inflam, inf, tumors, obstr, structural problems |
| manifestations of dysfunction | pain, hemorrhage, N/V, distention, constipation, diarrhea, abnormal fecal contents, incontinence |
| lactose intolerance | enzyme deficiency, missing lactace, afros and asians, undigested CHO |
| celia disease | automimmune damage to villi when gluten is consumed: wheat, oats, barley, rye |
| IBD | crohns and colitis |
| cystic fibrosis | genetic, mucus accumulation=pancreatic dysfunction, protein and fat digestion problems |
| steatorrhea | fatty stools |
| oxalates cause | kidney stones |
| inflam of hte gastrointestinal tract | gastroenteritis |
| gastroenteritis is caused by | inf organisms (virus, bacteria, parasites) |
| source of inf of gastro | contaminated food/water, contact w inf person, dirty utensils, fecal-oral, |
| patho of gastro | inflam alters secretion and absorption due to direct damage or production of toxins |
| s/s and dx of gastroenteritis | N/V, abd pain/flatulence, systemic fever, body aches, diarrhea, dehydration, electrolyte loss, stool |
| labs for dehydration | inc Hgb, inc Hct, inc BUN, inc Creat |
| labs for stool | ova/parasite, culture, WBCs, or toxins. test takes days d/t normal flora in stool |
| major health care associated inf | C. diff (clostridium difficele) |
| C. Diff occurs in.. | immunocompromised pt after antibiotic tx that destroys normal flora, spores last 70 days on surfaces |
| Tx for C. Diff | constact isolation, metronidazole (fLAGYL), vancomycin, stool transplant (not in immunocompromised) |
| diet for gastroenteritis | NPO until V stops, tx N/V, I/O, isolation, antibiotics, antimicrobials, no anti-diarrheals |
| IBS | chronic functional GI disorder, more in women |
| s/s IBS | abd pain, alternating diarrhea or constipation, flatulence, foul breath, N, anorexia, anxiety/depression, mucus stools |
| risks for IBS | stress, ETOH, smoking, lactose intol, specific food intol, psych factors |
| tx for IBS | high fiber (20gm), probiotics, low fat, no carb beverages or ETOH |
| meds for IBS | SSEI, loperamide (Imodium) for diarrhea, lubipostone (Amitzia) for constipation, alosetron (Lotronex) restricted access program |
| Inflammatory bowel disease | ulcerative colitis/chrones; chronic inflam of the GI tract, relapses/remissions, overractionto normal bacteria, 20yo and 60yo, genetic, more in whites |
| s/s of inflam bowel disease | diarrhea, bloody stools, wt loss, abd pain, fever, fatigue, skidney stones, liver disease, thromboembolism |
| complications of inflam bowel desease | hemorrhage, stricture/obstruction, perforation, fistula, colonic dilatation, nurtritional probs, sclerosing cholangisits, gallstones, liver failure |
| DX of inflam bowel diesease | labs, stool-+for blood, pus, mucus, signmoidoscopy, colonoscopy, EGD, barium enema, CT w contrast |
| IBD collaborative care goals | rest bowel, induce remission, , inflam control, correct malnutrition, reduce stress, stop smoking |
| meds for IBD | 5-aminosalicylate (saulfasalazine (Azulfidine)), antimicrobials, corticosteriods, immunosuppressants, biologic and targeted therapies, antidiarrheals (Imodium), hematologics and vit (iron, potassium, zinc) |
| nutritional therapy for IBD | fluid/electrolyte, high calorie, low fiber, residue, fat, small meals, no trigger foods, TPN |
| surgical intervention for chrones | common, high recurrence rate, short bowel syndrome, emergency situations |
| surgical intervention for ulcerative colitis | less common, total proctocolectomy is curative |
| dec freq, difficulty passing stools, dec volume, retained feces in the rectum | constipation |
| causes of contstipation | insufficient dietary fiber and fluids, dec physical activity, ignoring defecation urge, laxative abuse |
| causes of constipation related to age | dec secretion of digestive enzymes, dec muscle tone abd wall |
| s/s constipation | distention, bloating, flatulence, inc rectal pressure, hemorrhoid |
| related to venous engorgement with straining | hemorrhoids |
| related to Valsalva | cardiac problems |
| severe constipation, no stools/gas expelled | obstipation |
| accumulation of hardened stool that cant be expelled | fecal impaction-leaking of stool |
| tx for atonic constipation | high fiber, use natural foods, increase water intake , activity |
| diverticulosis | asymptomatice, seen w scope, high fiber diet, wt loss, no straining, tight clothes and lifting. no nuts/seeds |
| diverticulitis | pain, inc WBC, fever, CT scan, colon rest, NPO, IV fluids, progression of food first mush. |
| lesions of mucosal surface that progect into lumen of the bowel | colon polyp |
| non cancerous, limited growth | hyperplastic |
| linked to colorectal adenocarcenoma "mushroom" | adenomatous |
| third most common form of cancer in US, familia | colorectal cancer, second leading cause of death |
| risk factors for colorectal cancer | s/s dont appear until desease is advanced, obesity, smoling ETOH, large intake of processed meats |
| decrease risk for colorectal cancer | exercise, diet large mts of fruits, veggies and grains |
| s/s of colorectal cancer | pain, change in bowel habits, anemia, distention/obstruction, wt loss, N/V, black stools, blood in stool, hemorrhage |
| tx for colorectal cancer | resect tumor, restore bowel, ostomy, chemo, targeted biologics, radiation |
| targeted biologics for colorectal cancer | bevicizumb (Avastin)-prevents agiogenesis in the tumor, cetuximab (Erbitux) blocks epidermal growth factor receptor |
| skin assessment hx | onset/duration of problem, relationship (season, travel, etc), symptoms, hx oa associated illness |
| factors for assessment | good lighting, room comfortable temp, cosmetics removed, inspect mailbeds, oral mucous membranes on dark skinned pts. |
| decreased blood supply as in COPD, vascular disorders | cyanosis |
| vasicilation oas in fever cellutitis | flushing |
| skin lesion that drains from 1 hole, painful | furuncle |
| skin lesion that drains from any locations, usually staph, fever | carbuncle |
| purilant skin infection | pyoderma (pyo=puss) |
| furuncles/carbuncles need... | antibiotics and incision to drain |
| secondary skin inf | changes in skin due to scratching, irritation, inf, meds, invironment |
| blistering that is a response to a med | steven johnson |
| inflammation of subcutaneous tissue | cellulitis |
| s/s of cellulitis | hot, tender, red, edema, diffused borders |
| tx of cellulitis | moist heat, immobilization, elevation, antibiotic. can goto gangrene. no amb until under control |
| viral skin disease | very contagious, transmit easy, wore w immunosuppressed, avoid antibiotics (masks symptoms) |
| shingles | follows nerve pathways, pain before lesions, painful, fever, itch. |
| meds for shingles | Zovirax, Famvir, analgesics, steroids to relieve pain and itch |
| benign grown due to a virus | wart-verucca. bleeding can spread virus |
| skin fold appear moist and beefy red or brown, itch may have pustules on edge | fungal skin infections |
| tx for fungal skin inf | keep skin cool dry, leather, topicals |
| tenea capitis | craddle cap |
| candida | oral thrush |
| vitiligo | loss of skin pigment |
| chronic dermatitis, papular lesions with scalling borders, redness, mostly on scalp, elbow, knees | psoriasis |
| tx for psoriasis | UV light, tegison, methotrexate, corticosteroids |
| Tegison causes | birth defects, visual disturbances, hepititis |
| Methotrexate causes | liver toxicity, take no asprin |
| corticosteroids | apply after scales are removed, wet skin, cover w plastic |
| development of new pigment, sudden mole, loss/gain of hair, bleeding | seborrheic keratoses-mostly benign |
| tumor arising from melanocytes, metastasizes to any organ | melignant melanoma |
| gross distortion of reality, disturbances of language, communication, withdrawal, thought fragmentation | schizophrenia |
| s/s of schizophrenia | apathy, confusion, delusions, hallucinations, speech probs, bizarre behavior |
| persistent averant (incorrect) belief or perception that the pt cant b convinced otherwise despite of evidence to the contrary | delusional |
| sensory perception that doesnt result from an external stimulus in an awake state. auditory, gustatory, tactile, olfactory, visual | hallucinations |
| schizoid personality (schizophrenia phase 1) | loners, limited range of emotional expression, withdrawn |
| prodromal phase (2) | eccentric behavior, withdrawn, impaired role function, disturbances in communication, neglect of personal hygiene |
| schizophrenia (3) | delusions, hallucinations, disorganized speech, catatonic behavior |
| residual phase (4) | periods of remissions and exacerbations, depends on if they are taking meds or not |
| tx for schizophrenia | individual/group/behavioral therapy, |
| meds for schizophrenia | major tranquilizers, antipsychotic drugs. blocks dopamine in the brain |
| phenothiazines | thorazine, mellaril |
| thiozanthenes | navane |
| nonphenothiazines | haldol, zyprexa, resperdal |
| alteration in mood | depression |
| s/s depression | sadness, crying, withdrawn, cant concentrate, insomnia, anorexia, constipation, HA, fatigue |
| NS interventions | ask if they r thinking of killing self, make contract, meds, trust, make chage, set goals |
| anti depressio nmeds | effect neurotransmitter levels. MAOs, tricyclic antidepressants, slective serotonin, uptake inhibitors (SSRI), |
| MAOs | dont use much anymore, diet restrictions, many side effects |
| tricyclic antidepressants | Rememron, Desyrel |
| SSRIs | best ones. Clexa, Lexapro, Prozac, Paxil, Zoloft |
| Others | Wllbutrin, Cymbalta, Effexor |
| mood swings from profound depression to extreme euphoria (mania) | bipolar disorder |
| stage 1 | hypomania-good mood, helpful |
| stage 2 | everything is wonderful, euphoric, do inappropriate things, dec hygiene and sleep. |
| stage 3 | exaggerated mood swings, stooperous, confused, most unsafe |
| Ns interventons for bipolar | reduce stimuli, safety, calmness, set limits, meds |
| meds for bipolar | major tranquilizers, phenothiazines and lithium for the acute manic phases. can easily od on lithium |
| diffuse apprehension that is vague in nature and is associated with feeling of uncertainty and helplessness | anxiety disorder |
| affects ability to respond, more restless | moderate anxiety |
| unable to concentrate, cant complete task, HA, heart palpitations, insomnia, dread, horror | severe anxiety |
| unable to focus, hallucinations, delusions, withdrawn, confusion, feeling of terror, poor decisions | panic anxiety |
| anxiety disorder meds action | act at the limbic, thalamic and hypothalamic levels to produce calming |
| benzodiazepines | Xanax, Valium, Ativan |
| non-benzodiazepines | BuSpar, Atarax, Vistaril |
| others | tranquilizers |
| NS interventions for Anxiety disorders | any additional probs, what stressors, family support, accept, educate, coordinate care |
| assessment of suicide | elicit info, have a plan, hx of previous attempts, refuse to sign contract, live alone, ETOH, drugs, psychosis |
| Kubler-Ross stages of grieving | denial/isolation, anger, bargaining, depression, acceptance |
| worden and harper basic tasks of grief | accept the reality of the loss, experience the pain of grief, adjust to an environment in which the individual is missing, refocus emotional energy |
| risk factors for complicated grief | sudden death, marked dependence, lack of support system, loss of a child, perception of preventable death |
| NS interventions for grieving | support, assess how pt reacts to loss, understand the normal grief process, assess s/s of maladaptive response |
| maladaptive response to grieving | preserving, intense/distorted occurrences, mental/physical disorders, suicide |
| s/s of approaching death | extremities cool/discolored (molded), inc sleeping, hard to arouse, lose bowel/bladder control, poor swallow, restless, resp patterns change, can hear |
| if an autopsy is to be done... | leave all lines in. |
| criteria for hospice | terminal illness, death within one year, DNR status |
| how to deal w death at work | get help, know your limitations, leave work at work |
| ascending symmetric paralysis that usually affects cranial and pereipheral nervous system | Guillain-Barre Syndrome |
| Guillain-Barre Syndrome | loss of mylein, edema, inflam of affected nerves that stops or slows nerve impulses |
| Guillain-Barre Syndrome occurs after a... | upper respiratory or GI inf-resp failure most serious |
| Dx for GBS | CSF-elevated protein, EMG-nerve and muscle function in affected extremities |
| NS management of GBS | monitor ascending paralysis, resp functin, arterial blood gases, gag and swallowing reflexes, BP, HR and rythm |
| amyotrophic lateral sclerosis | Lou Gehrigs desease-rare, loss of motor neurons resulting in degeneration of motor neurons in the brainstem and spinal cord. |
| s/s of ALS | weakness upper extremities, dysarthria(difficulty articulating words), dysphagia, muscle twitching, pain, spasicity, drooling,const, esophageal reflux |
| Dx of ALS | nothing rule out others |
| px of ALS | death in 2-6yrs from resp inf |
| disease disseminated demyelination of the nerve fibers of the brain and spinal cord. | MS-multiple sclerosis-disease of the young to middle aged adults. |
| Risk factors for MS | women (2-3x more than men), 5x more in US, Canada and Europe than tropical, family relative w MS |
| MS is marked by | exacerbations/remissions. attack of mylin sheath then regrow of. slerotic plaque on nerves |
| dx of MS | hx, physical exam, clinical mans, lesions in brain from MRI |
| teaching for MS management | avoid triggers, balanced exercise, rest and nutrition, no hot/cold climate, exposure to inf, fatigue, follow drug regimen . |
| Chronic, progressive neurodegnerative disease | Parkinson’s Disease-Slowness in initiation/execution of movement, bradykinesia)Increased muscle tone.(rigidity)Tremor at rest. Gait disturbance. |
| Clinical Manifestations of parkinsons | gradual/insidious, r/l sided, 70 yo, more males |
| Beginning stages of parkinsons | Mild tremor (first sign) Slight limp,Decreased arm swing. |
| Later Stages of parkinsons | Shuffling Gait Propulsive gait with arms flexed,Loss of postural reflexes,Slight change in speech |
| Tremors of parkinsons | First sign,Pt. may only notice, Effect in handwritting,Aggravated by emotional stress,Tremors can involve:Diaphram,Tongue,Lips,Jaw |
| Rigidity of parkinsons | Second sign,Sustained muscle contractions,Muscle soreness,Feeling tired Achy Pain head, upper body, spine, and legs Slowness of movement |
| Bradykinesia of parkinsons | Loss of automatic movements(involuntary),Stooped posture,Masked face,Drooling,Shuffling gait |
| Diagnostic Studies of parkinsons | Not set test.Must have 2 of 3 symptoms present:Tremor,Rigidity, Bradykinesia; Ultimate confirmation is positive response to antiparkinsonian drugs |
| med for Parkinsons-levodopa/carbidopa (Sinemet) | Blocks the effects of the overactive cholinergic neurons. Treats bradydinesia, tremors, and rigidity |
| Anticholinergics | Artane, Cogentin, Akineton. Treats tremors |
| Antihistamine | Benadryl Treats tremors and rigidity |
| MOI | Eldepryl, Crebex, Azilect Treats bradydinesia, tremors, and rigidity |
| disease that destroys the brain | alzheimers-60 yo, genetic, b-amyloid plaques, neurofibrillary tangles, |
| s/s alzheimers | subtle memory loss, final stage unresponsive, incontinent |
| TIA | A transient ischemic attack episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but w/o acute infarction of the brain. |
| A stroke, caused by an event that causes more permanent damage to a larger area of the brain resulting in more widespread damage and more permanent disability | CVA Cerebral Vascular Accident-caused by plaque |
| A stroke that a patient is able to fully recover from within a few weeks. | RIND Reversible Ischemic Neurological Deficit |
| Etiology of a stroke | A stroke occurs when there is ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the brain that results in death of the brain cells |
| Risk factors for stroke | doubles each decade over 55yrs, more common in men, but more women die from it, African/ American, family history/heredity |
| modifiable Risk factors for stroke | Hypertension, Heart disease, Diabetes Mellitus, High cholesterol Smoking,Alcohol,Obesity, |
| Results from bleeding into the brain tissue itself or into the subarachnoid splace or ventricles. | Hemorrhagic stroke |
| Results from inadequate blood flow to the brain from partial or complete occlusion of an artery. | Ischemic Stroke |
| right hemisphere stroke | left-sided weakness, rash in judgement, inc falls, "left neglect", impulsivity, cant recognize body parts, probs w depth perception, cant see left in each eye(homonymous hemianopsia) |
| left hemisphere stroke | right-sided weakness, receptive/global aphasia, dec decision making, cant see right in each eye(homonymous hemianopsia), behavioral changes, apraxia |
| aphasia traditionally associated with neurological damage to Wernicke’s area in the brain. language area | Receptive aphasia |
| inability to properly move the muscles of the tongue and mouth to produce speech. | Expressive aphasia |
| impairment of both comprehension and expression of language. often mute or reduced to a few stereotyped words or sounds | Global aphasia |
| Inability to perform learned movements despite having desire and physical ability to perform them. | Apraxia |
| a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system | Dysarthria |
| a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function. | Seizure |
| a condition in which a person has spontaneously recurring seizures caused by a chronic underlying condition | Epilepsy |
| involve both sides of the brain, Loose consciousness for a few seconds to several minutes. | GENERALIZED |
| occurs in children, staring spell | absence seizures |
| loss of consciousness and falling to the ground | tonic clonic |
| Dx of seizure | EEG |
| peculiar sensation that precedes a seizure | aura |
| interventions for seizure | ensure airway, protect from injury, time seizure, say w pt until gone, pt on side, remove tight clothing |
| drugs for seizure | anti-convulsived- Ativan, Valium, Tegritol, Felbatol |
| drugs given IV for staticus epilepticus (rapid acting) | Ativan and Valium |
| Don’t take with grapefruit, report visual abnormalities, abrupt withdrawal after long term use may precipitate seizures. | Tegritol |
| Use is limited. It can cause aplastic anemia and liver toxicity. Mostly used to treat patients who are resistant to other drugs. | Felbatol |
| (long acting) anti-convulsive durgs | phenytoin, phenobarbital, ethosuximide, lamotrigine, topiramate |
| Dilantin | good oral hygene, tack 2-3 hours of antacids, use additional contraceptive |
| LEADING CAUSE OF BLINDNESS WORLDWIDE! | CATARACTS:An opacity within then lens |
| NON-SURGICAL tx for cateracts | changing prescriptions, using magnifiers, increasing the amount of light, adjusting his/her lifestyle, reassurance |
| surgical tx for cateracts | NPO 6-8hrs, antibiotic drops, dilation of eye, removal of lens nucleus and coretex, corticosteroid drops |
| post surgical instuctions | no stooping, lifting, coughing, call dr for any drainage, analgesic for pain |
| FOUR DISEASES MOST COMMONLY CAUSING BLINDNESS IN OLDER PERSON: | Cataracts, Viral infections, Chlamydial infections, Glaucoma |
| Clinical Manifestions of cateracts | decrease in vision (gradual), abnormal color perception, and glare. |
| related to consequences of increased intraocular pressure (IOP), optic nerve atrophy and peripheral visual field loss | GLAUCOMA-Second leading cause of permanent blindness and leading cause of blindness in African Americans. |
| the outflow of aqueous humor is decreased in the trabecular mesh work. Most common type. | Primary open-angle glaucoma (POAG) |
| due to reduction in the outflow of aqueous humor that results from angle closure. | Primary angle-closure glaucoma (PACG) |
| clinical mans of Primary angle-closure glaucoma (PACG) | N&V, sudden, excruciating pain in/around eye, halos around lights, blurred vision, ocular redness |
| clinical mans of Primary open-angle glaucoma (POAG) | Tunnel vision (PAOG) |
| Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers | RETINAL DETACHMENT |
| CLINICAL MANIFESTATIONS OF RETINAL DETACHMENT | Photopsia (light flashes), floaters, “cobwebs”,“hairnets”, Ring in the field of vision |
| The area of visual field loss is the center of the visual field (the macula) because of damage to the retina. | MACULAR DEGENERATION |
| Conductive Hearing Loss | cerumen (earwax build up, ear infection or sometimes tumors) to external/middle ear. |
| Damage to the inner ear functions can cause hearing and equillibrium problems | Sensori-Neural Hearing Loss-Can be abnormal at birth or caused by damage. |
| Hearing loss due to aging. | Sound transmission is diminished Loss of high pitched sound hearing Tinnitus Increased wax/hair production blocks sound transmission Loss of elasticity of cartilage Reduced blood supply to ear Decline in ability to filter out unwanted sound |
| Care of hearing aid | When not worn Remove or disconnect battery, Clean Ear molds weekly, ear tip w toothpick |
| determines hearing range of patient in terms of decibels (sound intensity), and Hertz (pitch) for diagnosis of conductive and sensorineural hearing loss. | Audiometry |
| can cause inconsistent results to audiometry | tinnitus |
| assessing vertigo ask... | hearing changes, dizziness or spinning, ringing in the ears, food allergies, staining during BM, changes in sleep, communication and during exercise |
| The cause is unknown but it results in an excessive accumulation of endolymph causing pressure in the membranous labyrinth (inner ear) | Meniere’s Disease |
| s/s of meniere's disease | severe attacks with nausea, vomiting, sweating and pallor, Tinnitus, fluctuating sensori-neural hearing loss, aural fullness. |
| meds for meniere's disease(during attacks) | Benadryl, atropine and ativan can be used to decrease the abnormal sensation and lessen N/V Antiemetics- Compazine Antivertigo- Antivert administered IV, orally or rectally |
| meds for meniere's disease(between attacks) | Antihistamines, calcium channel blockers and a low sodium diet Valium, fentanyl with innovar may be used to reduce the vertigo |
| Surgical interventions for meniere's | Decompression of endolyphatic sac and shunting, vestibular nerve resection, Labyrinthectomy |
| Patient care got meniere'sde | safe room, dark room (NO TV, lights on low),Assist patient to comfortable position,Have emesis basin at bedside,Keep bedrails up and bed in locked/low position, Instruct patient to use call light for assistance when getting up,Monitor I/O |
| Hydrops diet for meniere's | Restriction of sodium, caffeine, nicotine, alcohol and foods with MSG fluid buildups in the inner ear, lessen attacks |
| irritation of sensory branch of 5th cranial nerve | TRIGEMINAL NEURALGIA-in women >40, triggered by touch or temp |
| s/s of trigeminal neuralgia | intermittent, sudden-onset severe facial pain; unilateral; + blinking, tearing, jerking; unpredictable; clusters possible |
| tx for TN | antiseizure meds-decrease in neuron firing to block movement. |
| Cause: unknown, affects the motor aspects of the 7th CN (facial nerve), ? Inflammation RT Herpes virus | BELL’S PALSY |
| s/s of bells palsy | unilateral, drooping of mouth, eye rolls up when closing eyelid; can have difficulty with eating; tearing, lasts <6mtns |
| tx for bells palsy | MEDS: steroids, analgesics, eye protection PT/OT |
| abnormal, excessive, involuntary movements | HUNTINGTON’S DISEASE -chorea |
| autosomal dominant genetic disorder (men = women) that results in changes in neurotransmitters and degeneration of basal ganglia (onset most common 30-50 years) | HUNTINGTON’S DISEASE -chorea |
| s/s of huntingtons disease | progressive, death within 15-20 yrs Abnormal muscle movement: voluntary & involuntary impacted Emotional disturbances & personality change Intellectual decline |
| prion disorder (infectious protein) CNS disease; effects dependent on where proteins are active. Can be genetic or infectious. 4 – 21 yr incubation. | CREUTZFELDT-JAKOB DISEASE |
| s/s of CREUTZFELDT-JAKOB DISEASE | RAPID PROGRESSION (wks to months) Behavior and personality change CNS: memory, vision loss, dysphagia, abnormal movement |
| dx of CREUTZFELDT-JAKOB DISEASE | autopsy |
| bilateral, “pressing-tightening”, most common, mild-moderate; no triggering event. Duration 30 min – 7 days | tension HA |
| - rare, repeated HA over weeks or months; “sharp/stabbing”; periods of remission; swelling around eyes; congestion or tearing | cluster |
| recurring, often unilateral, “throbbing”; family tendency Improves with sleep. Can have N & V, photophobia and be preceded by prodrome. | migraine |
| meds and tx of HA | reduce inflammation of cerebral blood vessels & vasoconstrict, : diary to determine triggers, treat symptoms ASAP, rest, reduce stress, R/O other brain pathology |
| brain tumor arises from tissues within brain | primary |
| brain tumor metastatic, most common | secondary |
| s/s of brain tumor | HA, N & V (inc. ICP), Behavior change,Muscle weakness, Seizures, cognitive problems(Memory,Personality & mood) Sensory losses,Hydrocephalus |
| tx of brain tumors | Surgery, Radiation, Chemo, Symptom management: shunts |
| alterations in thought, acute, shorterm | confusion |
| temporary acuteconfusion,inattention Disorganized thinking Altered LOC | delirium |
| Chronic confusion Multiple memory problems Gradual decline | dementia |
| Records electrical activity of the brain using scalp electrodes. Noninvasive. | EEG- Electroencephalography-Clean hair, Check meds, NO CAFFEINE 8 hrs before test, |
| Records electrical activity associated with innervation of skeletal muscle. Needle electrodes into muscle. Normal skeletal muscle has no electrical activity at rest | EMG - Electromyography- looks at speed of depolarization |
| Computer-assisted xray of multiple cross sections. Noninvasive. | CT-Computed tomography-Some studies will utilize IV contrast media. |
| Uses magnetic field & radio waves to create detailed image | MRI – Magnetic resonance imaging, Greater contrast & better images of soft tissue. Can do 3D.Noninvasive but claustrophobic, noisy, and metal risks, Can use contrast media to enhance images, Pt must BE VERY STILL. |
| Measures the metabolic activity of tissue at the cellular level. (CT & MRI evaluate structural changes). | PET – Positron emission tomography-Requires IV injection of radioactive tracer.Provides 3D images. Can measure blood flow, O2 use, & glucose metabolism in tissues. Earlier detection of problems, Pt must BE VERY STILL. |
| Evaluates vascular status by inserting catheter (groin) & threading catheter to carotid and contrast inserted. | Angiogram (cerebral arteriogram-Serial images to evaluate flow of the dye, INVASIVE and risk of allergy due to contrast media.Aftercare of puncture site to prevent/detect bleeding |
| EMERGENCY TX OF ISCHEMIC STROKE | Recombinant tissue plasminogen activator(tPA): fibrinolysis – reestablishes circulation |
| ESSENTIAL MEDS FOR CVA | ANTI-PLATELET, ANTICOAGULANTS, Antihypertensives, Statins,Diabetic meds |
| interaction with the environment that promotes homeostasis | ADAPTATION: |
| loss of equilibrium, physical and mental illness, loss of identity and self-esteem | MALADAPTATION |
| Compensation | making up for a deficiency by emphasizing a feature considered an asset. |
| Conversion | unconsciously repressing an anxiety producing emotion conflict and causing difficulty sleeping, loss of appetite etc.... |
| Denial | avoiding emotional conflicts |
| Displacement | transferring anger over an interpersonal conflict to a malfunction VCR |
| Identification | acting like someone else |
| Dissociation | subjective sense of numbing and reduced awareness of ones surroundings |
| Regression | coping with stressor by going back to childhood |
| PSYCHOPHYSIOLOGICAL and should be tx like a real illness. Drs feel like these are in your head | HA, backache, arthritis, asthma, wheezing, diarrhea, anorexia, HB, Colds, infection, RA, GU, agina, hypertension, hypoglycemia, lupus |
| s/s of ETOH withdrawl | TREMORS, ANOREXIA, ANXIETY, RESTLESSNESS, INSOMNIA, ABDOMINAL PAIN, NAUSEA, DIAPHORESIS, |
| s/s of delirium tremmens from ETOH | DISORIENTATION, NIGHTMARES, VISUAL/AUDITORY HALLUCINATIONS, HYPERTENSION, DELUSIONS, CARDIAC PROBLEMS |
| TREATMENT FOR WITH- DRAWAL SYMPTOMS | SUPPORT, REASSURANCE, MONITOR, PROTECT FROM INJURY, one to one supervision |
| tx with meds for withdrawl | VALIUM -SERAX LIBRIUM -ANTIVAN |
| CHRONIC ALCOHOLISM can Cause Degeneration brain tissue Deficiency of Thiamine | Wernicke’s Encephalopathy-s/s=Ataxia, confusion, nystagmus. tx=IV Thiamine, Glucose replacement |
| Untreated Wernicke’s encephalopathy | Korsakoff’s Psychosis=s/s shorterm memory loss. tx=IV Thiamine, Glucose replacement |
| NICOTINE EFFECTS | TACHYCARDIA, VASOCONSTRICTS, dry ORAL MM, COUGH, LUNG DAMAGE, EMPHYSEMA, CANCER |
| Nicotine Replacement: | Nicotine gum, lozenges, patches, nasal spray, inhaler |
| Non-nicotine agents: | Zyban, Chantix, Aventyl, Catapres |
| abnormal malignant proliferation of plasma cells | MULTIPLE MYELOMA, middle to old, age 60 years, more common males and blacks |
| s/s of multiple myeloma | bone pain, anorexia, numbness, weakness, CHF, visual problems, headache, confusion, |
| DIAGNOSIS of MULTIPLE MYELOMA | x-ray, hematology=Bence-Jones protein--affects renal tubules increased calcium levels |
| TREATMENT MULTIPLE MYELOMA | chemotherapy, malphalan, prednisone anticalcium agents, localized radiation |
| Nursing Interventions MULTIPLE MYELOMA | high risk for injury, increase fluids, pain relief, prevent infection, rest and avoid fatigue, spinal brace |
| stage 1 lymphoma | single lymph node involvement |
| Stage two | two—two or more—one side of diaphragm |
| Stage three | lymph node involvement above and below the diaphragm |
| Stage four | involvement outside the diaphragm |
| Acute non-lymphcytic leukemia | resp. infections, anemia, bleeding mm, lymphoblasts inc.,hepatomegaly, splenomegaly, bone pain, CNS symptoms |
| Chronic myelogenous leukemia | fatigue, weakness, anorexia, wt. Loss, blastic phase, anemia, thrombocytopenia, fever, |
| etiology of leukemia | cause unknown, genetic predisposition, viral origins, radiation and chemical exposure, medication/drug related |
| Methods of transmission of HIV | intimate contact with body secretions, blood exposure, maternal-child transfer via placental exchange or breast milk |
| HIV Infection Control | Good hand washing, Do Not recap used needles, Use of gloves when handling body secretions, Disposal of contaminated materials |
| HIV acute inf stage | Flu-like syndrome, Acute retroviral syndrome, cold or flu, self-limiting |
| HIV early chronic inf stage | Asymptomatic disease, vague symptoms persist Median interval between infection and diagnosis 11 years |
| HIV Intermediate chronic inf stage | early symptoms become worse, thrush, shingles |
| Late chronic infection or AIDS | CDC criteria Opportunistic infections and cancers |
| normal function of T-calls | immune system function. norm>500. <200=aids. HIV uses T-cells to replicate |
| The amount of virus per milliliter of blood | VIRAL LOAD. The higher the viral load, the higher the risk of disease progression and/or death. low risk<10000. high risk>50000. |
| The CD4 count tells you the distance to the cliff. The viral load gives you the speed of the train. | Antiretrovirals (ART’s) are the “brakes” for this train. |
| HIV Encephalopathy | Brain invaded with virus, 60% of AIDS patients, neurological symptoms (impaired memory, slowness of speech, loss of function, loss of mental process) |
| HIV meds | Nucleoside Reverse Transcriptase Inhibitors, Protease inhibitors, Nonnumcleoside Reverse Transcriptase Inhibitors, Fusion Inhibitor |
| Nucleoside Reverse Transcriptase Inhibitors: | AZT -- malaise, HA, fever, nausea, vomiting, pancreatitis, neuropathy, oral lesions, rash, diarrhea, etc. Viread |
| Protease inhibitors | Crixivan, Viracept, Norvir |
| Nonnumcleoside Reverse Transcriptase Inhibitors | Rescriptor, Viramune |
| Fusion Inhibitor | Fuzeon |
| CHALLENGES OF HIV MANAGEMENT | Pill Burden, Food restrictions, Side Effects, Chronicity of the disease, Development of drug resistance, lipodystrophy Syndrome |
| HIV Dietary Recommendations | Lean meat, high protein, high calorie, Six small feedings, High in vitamin A, Vitamin C, Beta carotene, supplements to diet |
| HIV CDC Guidelines | Thoroughly cook meats, Avoid spoiled food, Reheat food well, Use bottled or distilled water, Do not leave food out of refridgerator more than 20 min. No unpasturized milk or cheese |
| Types of strokes | embolitic, thrombolitic, hemorragic |
| embolitic stroke | flows there, tissue dies, anticoags, heart holding blood (clots), activity onset, tpA. |
| thrombolitic stroke | grows there, antiplatelet meds r used, preceded by TIA, slow onset of symptoms, happens in AM, tpA |
| hemmoragic stroke | leak, have HA, from trauma, inc ICP, sudden onset, surgery to repair, get BP under control |
| #1 modifiable risk factor for stroke | HTN management, smoking |
| 3 main reasons a person seizes | hypoxia, fatigue, alcohol, stress |
| period of fatique with reduced responsiveness post siezure | postictal |
| how to report a seizure | clear scene, time it, lay on ground, add o2, conscious or not?? |
| absence seizure | just stare off |
| grand mall, tonic clonic | on the floor twitching |
| epilepsy | recurring seizures |
| classic signs of parkinsons | rigidity, brady kinesia, tremors, stoop, shuffles, pill rolling, lip smacking |
| myscemia gravis | auto immune, causes breathing difficulties, slowly dec, muscle probs, exhaust easily, removal of thymus gland, can paralyze resp muscles |
| MS | many plaques on nerves, remission/exacerbations, muscle, motor, urinary, sexual, emotional, cognitive impairments |
| ALS (amyotrophic lateral sclerosis) | 20-40 yo, no confusion, cant swallow, breath or eat. |
Created by:
vstein
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