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4th semester test 3

NCTC 4th semester test 3

Guillain-Barre syndrome Usually reversible and survivable Is the leading cause of acute flaccid paralysis most common presentation is characterized by ascending, symmetric paralysis that usually affects the cranial nerves and the autonomic nervous system
Guillain-Barre syndrome - Stages Acute stage can last up to 4 weeks plateau stage lasting from a few days to a few weeks, in which signs and symptoms remain constant. recovery stage, characterized by gradual improvement in signs and symptoms
What causes Guillain Barre Syndrome? May experience onset of signs and symptoms 1 to 3 weeks after an acute viral infection that was respiratory or gastrointestinal (GI) in origin Incidence increases generally with age, peaking most sharply from ages 50 to 74
Guillain Barre Syndrome s/s Motor weakness and paralysis usually begin in the legs, progressing to the trunk and arms. **Areflexia is considered a key assessment finding in GBS Cranial nerve involvement is present in 85% of cases
Diagnostic criteria for GBS progressive weakness of two or more limbs caused by neuropathy * areflexia * history of recent viral infection * elevated protein levels in cerebrospinal fluid (CSF) abnormal electromyography (EMG) results
Circle of Willis where many arteries anastomose together at base of brain Most common area for aneurysm formation, especially at midlife Congenital malformation of this area in half human population
Cranial Nerve 1 Smell - odor identification each nostril
Cranial Nerve 2 Vision - Central, peripheral, light/dark, read words
Cranial Nerve 3 Eye Motor - Move up/down/in, PERRLA, Raise eyelids, Constrict pupils
Cranial Nerve 4 and 6 Eye Motor - Move eyes down/in (4) outward (6)
Cranial Nerve 7 Face and Taste - Taste anterior 2/3 tongue, Make faces (smile, winch, puff cheeks, note symmetry)
Cranial Nerve 8 Hearing - Acuity of words or tuning fork test
Cranial Nerve 9, 10 Speaking - Swallowing, hoarseness, uvula symmetry, gag reflex
Cranial Nerve 11 Shrug- Shoulder muscle strength
Cranial Nerve 12 Tongue - Note deviation to one side, push tongue against cheek
Autoregulation Brains are self-protective and attempt to prevent hyperemia or subflow states by regulating diameter of arterioles Done by controlling pressure and chemistry ↑BP or ↓PaCO2 = constriction ↓BP or ↑PaCO2 = dilation
Cerebral Lobes - Frontal (motor strip) voluntary motor, intellect, judgment, personality
Cerebral Lobes-Parietal (sensory strip) sensory speech, sensory for opposite side of body
Cerebral Lobes - Temporal (hearing, speech, emotions)
Cerebral Lobes -Occipital (vision)
Cerebellum Lies behind the brain stem (lower back of brain) Motor center (muscle tone, posture, locomotion, coordination)
Autoregulation Done by controlling pressure and chemistry ↑BP or ↓PaCO2 = constriction ↓BP or ↑PaCO2 = dilation
Possible Therapies for Increased ICP/Preventing Secondary Brain Injury Positioning of patient Maintain normal serum glucose Avoid noxious stimuli Avoid clustering activities Avoid Valsalva maneuver Avoid excessive suctioning Maintain adequate oxygenation Maintain PaCO2 between 35-40 Volume Resuscitation
Possible Therapies for Increased ICP/Preventing Secondary Brain Injury Mannitol May cause rebound effect in hours (increase in ICP after Mannitol wears off), so often given with Lasix Observe for dehydration Observe Na+, K+, Cl- levels every 4-6 hours Must use IV filter with Mannitol, must be warm or will crystallize
Possible Therapies for Increased ICP/Preventing Secondary Brain Injury Lasix With Mannitol to pull fluid from vascular system into urine May decrease CSF production Induced Hypothermia after head injury
Possible Therapies for Increased ICP/Preventing Secondary Brain Injury Drainage of CSF Cerebyx or Dilantin IV Diamox Barbiturate Coma Neuromuscular Blockers Sedatives & Hyponotics Nimotop Steroids Avoid vasodilatory drugs Hypervolemia/Hemodilutional/Hypertension
Doll’s Eyes Oculocephalic – evaluates brain stem function (nerves 3,6,8) Briskly rotate head Present (eyes should move in opposite direction of head) Absent (eyes do not move in sockets but follow passively) indicates severe lesion of brain stem
Oculovestibular – evaluates brain stem function Ice water into patient’s ear canal Intact reflex (normal to have nystagmus, deviate toward the side with cold fluid and move away rapidly, nausea Abnormal (asymmetrical movements) Absent reflex (passive eye movements)
Intracranial Aneurysm/Subarachnoid Hemorrhage Nimotop (Ca channel-blocker selective to intracranium) prevents vasospasm Hypervolemia/hypertensive/hyperdilutional therapy (Triple H) includes Iv Fluids, Dopamine, Albumin or other volume expanders
Spinal Shock Temporary flaccid paralysis and loss of reflexes below lesion Hypotension and bradycardia and maintaining body heat are problems
Autonomic Dysreflexia An over reaction to the sympathetic nervous system in patients with injury T6 or above Check first for distended bladder or obstructed urine output Check next for bowel distention/impaction Elevated BP most threatening symptom
Precipitating Factors for Autonomic Dysreflexia Scrotal compression, Epididymitis, Ejaculation, Sexual intercourse, menstruation, pregnancy, uterine contractions/vaginal child birth, vaginitis Constrictive clothing/appliance, bone fractures, surgical procedures, pain, temperature fluctuations
Myasthenia gravis - Symptoms weakness of the voluntary (skeletal) muscles worsens with activity and improves with rest. Breathing difficulty because of weakness of the chest wall muscles Chewing or swallowing difficulty,
myasthetnic crisis life-threatening breathing problems.
Naegele’s Rule (LMP - 3 months) + 7 days
Bipolar disorder Lithium carbonate (Eskalith)
ADD/CNS stimulant Methylphenidate hydrochloride (Ritalin) Pemoline (Cylert)
Depression/tricyclic type Amitriptyline hydrochloride (Elavil) Nortriptyline hydrochloride (Aventyl, Pamelor)
Depression/MAOI Phenelzine sulfite (Nardil) Tranylcypromine sulfate (Parnate)
Depression/SSRI Paroxetine (Paxil) Fluoxetine hydrochloride (Prozac) Sertraline hydrochloride (Zoloft)
Depression/atypical or other Venlafaxine (Effexor) Bupropion hydrochloride (Wellbutrin)
The class of drug that is closely related to methylphenidate Amphetamines
Condition exhibiting signs of both clinical depression and mania Bipolar disorder
Enzyme that breaks down cathecholamine neurotransmitters in the synapse Monoamine oxidase
Chemical found in medications that cannot be ingested by patients on MAOIs due to high risk for sever hypertension Tyramine
Accumulation of serotonin when taking two drugs that reduce serotonin uptake Serotonin syndrome
Psychosis/phenothiazine – lethargy with extrapyramidal se bone marrow supression Thioridazine (Mellaril) Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Loxapine (Loxitane)
Psychosis/nonphenothiazine Haloperidol (Haldol) Thiothixene (Navane)
Psychosis/atypical Olanzapine (Zyprexa) Clozapine (Clozaril) Risperidone (Resperadal)
Dopamine system stabilizers Aripiprazole (Abilify)
Paranoid An extreme suspicion that one is being followed, or that others are trying to harm oneself
Delusions Firm ideas and beliefs not founded in reality
Hallucinations Seeing, hearing, or feeling something that is not there
Positive symptoms Symptoms that are added to normal behavior
Negative symptoms Symptoms that subtract from a normal behavior
Schizoaffective disorders A condition in which the patient exhibits symptoms of both schizophrenia and mood disorders
Neuroleptic A term meaning “antipsychotic medications”
Anticholinergics A class of drug that might be used to decrease extrapyramidal effects
Extrapyramidal effects A movement disorder brought on by medication effects
Presumptive no period changes in breasts
Probable enlarged abdomen positive pregnancy test goodall sign chadwicks palpable fetal outline
positive see or hear fetus
when need to give rhogram within 72 hours of exposure 28 weeks prophylacticly
Children vs adults Respiratory System Differences Epiglottis located at level of cervical spine 1 Older child located at C3 Adult located at C4 to C5 Tongue large relative to head size; fills oral cavity Infants obligate nose breathers until between 4-6 months
Infant/child usually experiences respiratory failure more often than primary cardiac failure If cardiopulmonary failure usually tend to have bradycardia and apnea – not ventricular dysrythmias
Heart Failure - children usually exhibit manifestations of both right- and left-sided failure Infants exhibit change in responsivenss; lethergic, irritable, respiratory disgress with dyspnea; tachypnea, retractions, nasal flaring, grunting Digoxin inotropic drug of choice
One Month Physical Gain 5-7 ounces weekly Motor Turn head Sensory Follows light to midline Socialization Utters small throaty sounds
Two to Three Months Physical Posterior fontanel closes Motor Can carry object to mouth Plays with hands/fingers Sensory Listens to sounds Socialization and vocalization Smiles, laughs, shows pleasure with sounds Cries less
Four to Five Months Birth weigh doubles Drools Balances head when sitting Reaches for and grasps objects Rolls over Recognizes familiar objects Socialization and vocalization Coos and gurgles Enjoys social interaction Vocalizes displeasure when an object is taken aw
Six to Seven Months Physical Teething may begin Motor Sit fairly well unsupported Can transfer toys in hands Plays with feet Everything to the mouth Sensory Has taste preferences Socialization and vocalization Stranger anxiety begins Laughs and cries easily
Eight to Nine Months Motor Develops pincer grasp Crawls and creeps Sensory Interested in small objects Socialization and vocalization Reacts to adult anger Uses vowels and consonants “Dada” Comprehends “bye-bye”
Ten to Twelve Months Birth weight triples Stands alone Walks with help Eats with a spoon Plays pat-a-cake Puts arm through sleeve Shows jealousy, affection, anger Explores away from mother Security blanket Knows name Understands verbal requests
Hep B vaccine schedule Birth 1 month 6 months
Toddler 15 months Walks alone Builds towels of 2 blocks Enjoys throwing objects Vocalization and socialization 10-15 words “No” Indicates when diaper is wet
18 months Abdomen larger than chest Motor Finger foods Runs well Vocalization and socialization Temper tantrums Very ritualistic Favorite toy, blanket, etc.
Two Years and 30 Months 26-28 pounds 32-33 inches Walks up and down stairs Controls spoon Toilet trained in daytime Uses pronouns Obeys simple commands Can help undress self Increasing autonomy Decreased need for naps Independent, ritualistic, negative
Pre-School 3, 4, 5 years Cooperative Play Loosely organized group play Learns to deal with reality, to control feelings, express emotions Increased sharing and cooperation
Common Childhood Illness Cardiovascular Disorders Congenital shunts Left-to-right because left usually functioning under higher pressure than right =Increased pulmonary blood flow Right-to-left – cyanosis occurs Treat with prostaglandin E1 Temporarily maintains patency of ductus arteriosus until surgery performed
Measles (rubeola) Incubation 7-14 days; Koplik’s spots on oral mucosa (small, bright red spots with bluish-white speck in center; rash begins behind ears and spreads downward to feet Needs respiratory isolation
German measles (rubella) Incubation 14-21 days; infectious 10 days before onset of symptoms to 15 days after rash appears; airborne, direct contact with droplets, transplacental Needs contact isolation
Mumps Incubation 16 to 18 days but may extend to 25 days Airborne droplets; saliva and possibly urine
Chickenpox Incubation 10-21 days; infectious 1-2 days before onset of rash to 5 days after onset of lesions and crusting of lesions Direct contact, droplet, airborne particles
Created by: kcorkinsnctc