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Exam 15- Nervous sys

68WM6 Exam block 15- Nervous System

QuestionAnswer
loss of ability to recognize familiar objects and persons agnosia
localized dilation of the wall of a blood vessel aneurysm
abnormal neurological condition in which the language function is defective or absent because of an injury to certain areas of the cerebral cortex aphasia
inability to perform purposeful acts or to use objects properly apraxia
abnormal condition characterized by impaired ability to coordinate movement ataxia
slowing down the initiation or execution of movement bradykinesia
double vision diplopia
difficult, poorly articulated speech that results from interference in control of the muscles of speech dysarthria
weak, soft, flabby, muscles, lacking normal muscle tone flaccid
generalized impairment of intellect, awareness and judgement global cognitive dysfunction.
defective vision or blindness in half of the visual field hemianopia
paralysis of one side of the body hemiplegia
neurologic condition characterized by increased reflex action hyperreflexia
involuntary rhythmic movements of the eye nystagmus
lesser degree of movement deficit than paralysis paresis
rest period after a seizure postictal period
sensation of spatial-position and muscular activity stimuli proprioception
involuntary, sudden movement or muscular contraction spastic
perceptually unaware of one side of the body unilateral neglect
1. loss of brain weight and neurons 2. altered sleep/wake ratio 3. decrease ability to regulate body temp. 4. decrease blood supply to spinal cord- decrease reflexes 5. diminished sense of touch and fine motor skills 6. short-term memory affected physiologic changes associated with aging
1. orientation to person, place, time, and purpose 2. mood and behavior 3. general knowledge 4. short and long term memory 5. attention span 6. ability to concentrate mental status- neurological assessment
responsiveness to auditory, visual, and tactile stimuli arousal
reflected in orientation to person, place and time awareness
first signs of ICP restlessness, lethargy, and disorientation.
CN I olfactory- identification of common odors
CN II optic- visual acuity and visual fields
CN III oculomotor- pupillary responses: size, shape, reactivity bilaterally
CN IV trochlear- tested with CN III
CN V trigeminal- jaw strength, facial sensation, corneal reflex
CN VI abducens- tested with CN III
CN VII facial- face moves in symmetry, identification of taste (sensory)
CN VIII acoustic- hearing
CN IX glossopharyngeal- taste
CN X vagus- gag reflex, movement of the uvula and soft palate
CN XI spinal accessory- shoulder and neck movement
CN XII hypoglossal- tongue movement
Nursing considerations for CT scan 1. 30-60 minutes of lying still 2. IV line (contrast medium) 3. claustrophobia 4. allergy to iodine/seafood
Nursing considerations for brain scan/echoencephalogram 1. 45 minutes time 2. IV line
Nursing considerations for MRI 1. remove watches, jewelry, any metal 2. inquire about metal in body
Nursing considerations for PET 1. 45 minutes lying still 2. IV line
Nursing considerations for lumbar puncture 1. 10-15 min 2. slight pain and pressure 3. slight bleeding 4. lie flat for several hours to avoid headaches 5. sharp pain shooting down one leg 6. position- on side with knee and head flexed
Nursing considerations for electroencephalography 1. patient must be quiet and rest before procedure 2. one hour to complete 3. hair and scalp clean 4. wash hair to remove electrode paste 5. must rest after procedure
Nursing considerations for myelogram 1. 2 hours to complete 2. slight discomfort 3. IV (allergies to contrast) 4. CT scan after 5. headache, n/v side effects
Nursing considerations for angiography 1. NPO or clear fluids 2. allergies to contrast 3. 2-3 hours 4. bedrest after procedure 5. at risk for CVA and ICP
cephalalagia headaches
where does pain arise in headaches? scalp, its blood vessels and muscles, and from dura mater and venous sinuses, skull and brain tissues contain no sensory neurons
vascular headaches 1. migraine 2. cluster 3. hypertensive
tension headaches 1. psychological cause 2. medical cause 3. stress
traction- inflammatory headaches 1. intracranial and extracranial causes 2. occlusive vascular structures 3. infection 4. temporal arthritis
manifestations of migraine 1. n/v 2. senstitivity to light 3. chills, diaphoresis 4. irritability, fatigue 5. edema
contributing factors to migraines 1. emotional stress 2. excess carbohydrates 3. iodine rich foods 4. alcohol 5. chemical additives 6. fatigue 7. caffeine
1. specific peripheral nerve problem 2. caused by degeneration or pressure on the fifth cranial nerve 3. also known as Tic douloureux 4. usually middle to late adulthood 5. slightly more common in women trigeminal neuralgia
manifestations of trigeminal neuralgia 1. pain radiates along one or more of the three divisions of fifth cranial nerve 2. excruciating knifelike/lightening like shock in lips,gums, cheek, forehead, or side of nose 3. few seconds or minutes 4. reoccurance unpredictable
drugs for trigeminal neuralgia 1. tegretol 2. dilantin 3. depakene 4. neuontin
1. thought to be caused by an inflammatory process involving CN VII (facial) 2. etiology unknown- evidence that reactivated HSV may be involved 3. causes pain and disturbances in motor and sensory function Bell's Palsy (Peipheral Facial Paralysis)
1. gliomas 2. meningiomas 3. pituitary tumors 4. neuromas intracranial tumors
Medications used for intracranial tumors 1. osmotic diuretics 2. corticosteriods 3. anticonvulsants 4. dilantin
1. second most commone cause of neurological injury 2. major cause of death between ages of 1-35 3. effects can lead to cerebral edema, IICP, and sensory and/or motor deficits craniocerebral trauma
causes of head injury 1. MVAs 2. falls 3. sports 4. industrial accidents 5. assaults
open head injuries 1. linear 2. comminuted 3. depressed 4. compound 5. fractures at base of skull are more serious
closed head injuries 1. laceration 2. concussion 3. contusion
hematoma 1. results from hemorrhage post-craniocerebral trauma 2. epidural 3. subdural 4. intracerebral 5. individuals at high risk: anticoagulant, underlying bleeding disorder
1. bleeding between dura and skull 2. initial consciousness, regains, then coma 3. ipsilateral pupil changes 4. contralateral hemiparesis epidural hematoma
1. venous bleeding between dura and subarachnoid layers 2. usually slower bleed 3. progressive deterioration of LOC 4. ipsilateral pupil changes 5. decreased extraocular muscle movement subdural hematoma
1. bleeding into the brain tissue 2. classic signs of IICP intracerebral hematoma
signs of IICP 1. LOC 2.HA 3. vomiting 4. changes in VS 5. pupil changes 6. posturing
s/s of hematoma 1. nausea 2. rhinorrhea/otorrhea 3. signs of IICP 4. seizures 5. abnormal speech 6. signs of basilar skull fracture
1. battle sign 2. raccoon eyes basilar skull fracture signs
medical management of simple skull fracture 1. bedrest 2. observations for IICP 3. scalp lacerations
medical management of depressed skull fracture 1. surgical intervention 2. antibiotics 3. control IICP 4. anticonvulsants
medical management for concussion 1. rest 2. tylenol for analgesia 3. observe for complications
medical management for contusion 1. CT and/or MRI 2. drug therapy 3. assist ventilations as required
medical management for hematoma 1. relieve pressure, stop bleeding, or remove clot 2. Burr holes, craniotomy, craniectomy, cranioplasty
characteristics of cluster headaches 1. episodic- 20 minutes to 2 hours 2. occur in clusters 3. 2-10 per day 4. pain on one side of the head usually around or behind one eye 5. very little time between onset and maximum pain
pinna or auricle external auditory canal
tinnitus a subjective noise sensation heard in one or both ears,ringing or tinkling sounds in the ear
vertigo the sensation that the outer world is revolving about oneself or that one is moving in space
Weber's test 1.test is performed by placing the stem of a vibration tuning fork in the center of the patients forehead or on the maxillary incisors 2. loudness is equal in both ears= hearing normal 3. loudness is greater in one ear= hearing abnormal
otoscopy direct visualization of the external auditory canal and the eardrum
otitis externa infection of the external ear and adjacent skin
otitis media fluid from an infection, allegy or tumor that collects in the middle ear as a result of obstruction of the auditory tube
labryinthitis an inflammation of the labyrinthine canals of the inner ear
otosclerosis a condition characterized by chronic progressive deafness cause by the formation of spongy bone, withresulting ankylosis of the stapes, causing tinnitus and deafness
Meniere's disease disturbance of the semicircular canals that results in tinnitus and unilateral deafness
stapedectomy removal of the stapes of the middle ear and insertion of a graft and prosthesis
tympanoplasty any of several operative procedures on the eardrum or ossicles of the middle ear designed to restore or improve hearing in patients with conductive hearing loss
myringotomy a surgical incision of the eardrum performed to relieve pressure and release purulent exudates from the middle ear
normal aging causes decreased hearing due to: 1. deterioration of the nerve fibers and breakdown of the cells in the organ of Corti 2. loss of the ability to hear high frequencies and distinguish consonant sounds
Rinner test 1. tuning fork placed 0.5 inch from the external auditory meatus and the vibrating stem placed over the mastoid bone 2. one ear tested, the other masked 3. sensorineural loss- longer by bone conduction
vestibular testing measures balance and equilibrium
1. caused by any disease or injury that interferes with conduction of sound waves to the inner ear 2. treatment- remove excess cerumen from external acoustic meatus, hearing aid, surgery to restore ossicles conductive hearing loss
1. results from malfunction of the inner ear, vestibulocochlear nerve, or auditory center of the brain 2. caused by arteriosclerosis, tumor of 8th CN, infection, ototoxic drugs,prolonged exposure to loud noise 3. usually irreversible sensorineural hearing loss
combination of conductive and sensorineural mixed hearing loss
1. psychogenic or nonorganic hearing loss functional hearing loss
1. present at birth or early infancy 2. may be caused by Rh incompatibility 3. mothers exposure to syphillis or rubella 4. use of ototoxic drugs during pregnancy congenital hearing loss
1. pain 2. redness 3. swelling 4. diminished hearing clinical manifestations of otitis externa
auritory pathways in the brain are damaged, i.e. stroke central hearing loss
1. oral analgesics 2. corticosteroids to reduce edema 3. antimicrobial agents 4. insertion of wick 5. warm soaks 6.cleanliness medical management of otitis externa
1. feeling of fullness in the ear 2. some hearing loss 3. severe, deep throbbing pain 4. tinnitus 5. fever clinical manifestations of otitis media
1. antibiotic therapy 2. myringotomy 3. analgesics 4. sedatives 5. local heat and nasal decongestants 6. needle aspiration medical management of otitis media
1. severe and sudden vertigo 2. nausea and vomiting 3. nystagmus 4. photophobia 5. headache 6. ataxic gait clinical manifestations of labyrinthitis
1. administer prescribed abx and meds for vertigo 2. monitor I&O to prevent dehydration 3. note frequency and degree of vertigo nursing management of labyrinthitis
1. slow, progressive conductive hearing loss 2. patient describes a low to medium pitched tinnitus 3. deafness usually first noted between ages 11-20 clinical manifestations of otosclerosis
medical management of otosclerosis stapedectomy
1. vertigo w/associated nausea and tinnitus 2. hearing loss 3. sudden movement aggravate attacks 4. attacks cause n/v, diaphoresis, tinnitus, and nystagmus clinical manifestations of Meniere's disease
1. maintain low-salt diet and administer diuretics 2. bed rest, sedation, and administration of antiemetics to treat vertigo 3. alternate method of communication if hearing deficit nursing management of Meniere's disease
fetid rank odor
nursing interventions for stapedectomy 1. do not turn patient 2. open mouth when sneezing or coughing 3. blow nose gently one side at a time for 1 week
nursing interventions for tympanoplasty 1. bed rest w/ HOB elevated 40 degrees and operative side faces upward 2. note amount, color, consistency of drainage 3. monitor vitals, especially temp 4. monitor for signs of graft displacement
nursing interventions for myringotomy 1. note color, consistency, and amount of drainage 2. maintain cotton to absorb drainage 3. change cotton frequently
carbamide peroxide (Debrox) 1. cerumen removal 2. don't use if eardrum perforated or ear discharge
colistin/myomycin/hydrocortisone/thonzonium (Coly-Mycin S Otic) 1.antibiotic/steroid/detergent used for susceptible disease of external auditory canal, mastoidectomy, and otitis media fenestration 2. do not heat above body temp 3. shake well before using 4. use cotton plug to keep moist
meclizine hydrochloride (Antivert) 1. anticholinergic antihistimine that acts as antiemetic, antivertigo agent 2. give with food, water or milk 3. avoid alcohol and CNS depressants
antiphyrine/benzoaine (Auralgan) 1. analgesic, local anesthetic, used for otitis media adjunct to cerumen removal 2. discard bottle and discard after 6 months from first use 3. warm bottle 4. place patient on side and fill ear canal 5. use cotton plug
acetic acid (Vo Sol Hydrochloride Otic) 1. antibacterial, antifungal, astringent, used for superficial infections of the external auditory canal 2. do not wash dropper 3. use cotton plug for first 24 hours 4. contact physician if condition or no improvement in 5-7 days
an abnormal condition of the blood vessels of the brain characterized by hemorrhage into the brain or formation of an embolus or thrombus that occludes an artery resulting in ischemia of the brain tissue normally perfused by the damaged blood vessels cerebrovascular accident (CVA)
1. thrombotic or embolic 2. account for 85% of strokes ischemic stroke
risk factors for ischemic stroke 1. use of oral contraceptives 2. coagulation disorders 3. polycythemia vera 4. arteritis 5. chronic hypoxia 6. dehydration
1. account for 15% of strokes 2. intracerebral (bleeding into brain tissue or 3. intracranial (bleeding into the subarachnoid space) hemorrhagic stroke
common causes of hemorrhagic stroke 1. hemorrhagic disease 2. severe hypertension 3. brain tumors 4. aneurysm
localized dilation of the wall of a blood vessel usually caused by atherosclerosis or HTN aneurysm
an episode of cerebrovascular insufficiency with temporary episodes of neurological dysfunction that can vary in severity, lasting 15minutes- 24 hours transient ischemic attack (TIA)
1/3 of TIA patients will have a stroke within... 5 years
1. hypertension 2. artherosclerosis 3. cardiac disease 4. diabetes mellitus 5. kidney disease 6. cigarette smoking 7. stress 8. sedentary lifestyle 9. oral contraceptives risk factors for stroke
1. hemiparesis or hemiplegia 2. change in LOC 3. signs of increased ICP 4. respiratory problems 5. presence of aphasia or dysphagia 6. impaired coordination 7.contralateral sensory loss 8. s[atial-perceptual deficits manifestations of stroke
diagnositic testing for stroke 1. CT and MRI 2. PET 3. cerebral angiography 4. ultrasonography 5. lumbar puncture
anticoagulation therapy used in patients with _________ but contraindicated in ________ thromblytic stroke, hemorrhagic stroke
1. ASA 2. dipyridamole (Persantine) 3. ticlopidine (Ticlid) 4. clopidogrel (Plavix) platelet antiaggregation medication (contraindicated in hemorrhagic stroke)
surgical management for hemorrhagic stroke 1. evaluate the clot 2. aneurysm clipped or tied off
1. vasodilators 2. osmotic diuretics 3. dexamethasone to reduce ICP 4. fluid restriction 5. suppositories, laxatives, or stool softeners medical management of stroke
carotid endarterectomy if artherosclerosis of carotid artery is the cause of a stroke
craniotomy treatment of aneurysm
injuries to cervical areas C5, C6, and C7 tetraplegic (quadriplegic)
injury to junction of the thoracic and lumbar vertebrae T12-L1 or sacral segments paraplegic
flexion injury seen with rapid deceleration injuries, whiplash
extension injury seen with rapid deceleration injuries, whiplash
flexion rotation injury twisting of the spinal cord
complete or total transection all voluntary movement below the level of injury is lost
signs and symptoms for a complete transection 1.total sensory loss and motor paralysis below level of injury 2.loss of bowel and bladder control 3. loss of sweating and vasomotor tone below the level 4. loss of blood pressure due to loss of PVR 5. pain 6. respiratory problems
spinal shock (areflexia) 1.complete loss of motor, sensory, reflex, and autonomic activity below the level of the lesion 2. temporary, spontaneously resolves days to weeks later
1. exaggerated sympathetic nervous system response 2. occurs in patients with cord injuries at T6 and above 3. can occur suddenly at any time after spinal shock subsides autonomic dysreflexia (hyperreflex)
clinical signs of autonomic dysreflexia 1. severe bradycardia 2. hypertension 3. severe pounding headache 4. flushed skin with gooseflesh 5. blurred vision, dilated pupils 6. anxiety 7. nausea
place patient in ___________ position for autonomic dysreflexia to decrease BP High-Fowlers
drugs for autonomic dysreflexia 1. ganglionic blocking agents 2. vasodilators
cervical injury to C1-C3 1. movement in neck and above 2. loss of innervations to diaphragm 3. absence of independent respiratory function 4. often fatal
cervical injury above C4 1. tetraplegia 2. sensationa and movement in neck and above 3. may be able to breath without a ventilator
cervical injury C4/C5 1. some shoulder movement 2. may require respiratory support
cervical injury C6 1.shoulder and upper back abduction and rotation at shoulder 2. full biceps to elbow flexion, wrist extension, weak grasp of thumb 3. decreased respiratory reserve
cervical injury C7-C8 1. all triceps to elbox extension, finger extensors and flexors 2. good grasp with some decreased strength 3. decreased respiratory reserve
thoracic injury T1-T6 1. paralysis below the waist with control of hands 2. abdominal breathing 3. full innervations of upper extremities and back 4. full hand strength and dexterity of grasp 5. decreased trunk stability
thoracic injury T7-T12 1. varying degrees of trunk and abdominal control 2. functional intercostals 3. increased respiratory reserve
lumbar injury L1-2 1. hip abduction impaired 2. no sensation below lower abdomen
lumbar injury L3-5 1. knee and ankle movement impaired 2. no sensation below upper thigh
sacral injuries 1. bowel/bladder dysfunction 2. variable motor and sensory loss in lower extremities and perineum
predisposing factors to seizures 1. high fever 2. electrolyte imbalances 3. uremia 4. brain tumor 5. drug/alcohol withdrawal 6. hypoxia 7. idiopathic 8. trauma/injury
tonic-clonic (grand mal) 1.most common type of seizure 2. usually proceeded by aura 3. LOC for several minutes 4. incontinience 5. postictal: headache and sleep for 1-2 hours
absence (petit mal) 1. usually occurs during childhood and adolescence 2.usually decrease in frequency as child gets older 3. characterized by sudden impairment in LOC with litte or no tonic-clonic movement 4. sudden vacant facial expression 5. no postictal, no aura
psychomotor 1. occurs at any age 2. similar to absence seizure, but lastes longer 3. aura with complex hallucinations or illusions 4. postictal period marked by confusion, amnesia, and need for sleep
jacksonian 1. in patients with structural brain disease 2. spasms of musculature that begin in a certain area of the bodu (usually hand, foot, face) and move throughout a portion or all of the body 3. may end in a grand mal seizure 4. aura is numbeness, tingling
myoclonic 1. my antedate grand mal by months or years 2. may have mild or rapid, forceful movements 3. sudden involuntary contraction of a muscle group usually in extremity 4. no LOC 5. no aura or postictal
akinetic 1. uncommon 2. characterized by a peculiar generalized tonelessness 3. person falls in a flaccid state and is unconscious for a minute or two 4. rare aura 5. no postictal period
indications for surgical management of the patient with epilepsy/seizures 1. brain tumors 2. brain abscesses 3. cysts 4. cortical scars due to cerebral trauma/birth injuries 5. treatment with drugs has been ineffective
barbituates 1. generalized tonic-clonic, partial, febrile seizures in children 2. i.e.: pentobarbital, phenobarbital
benzodiazepines 1. clonazepam- prophylaxis of petit mal, myoclonic, akinetic seizures 2. clorazepate- management of simple partial seizures 3. diazepam- treatment of status epilepticus/uncontrolled seizures
hydantoins 1. fosphenytoin- short-term parenteral in acure generalized tonic-clonic, status epilepticus, prevent and treat seizures in neurosurgery 2. phenytoin- generalized tonic-clonic, focal, psychomotor seizures
valproates 1. absence seizures 2. i.e. divalproex sodium, valproate sodium, valproic acid
anti-convulsant agents side effects 1. nystagmus 2. slurred speech 3. mental confusion 4. gingival hyperplasia 5. nausea/vomiting 6. consipation or diarrhea
meningitis 1. inflammation of the meninges 2. causes may be bacterial, viral, or fungal
meningitis signs and symptoms 1. fever 2. pain and stiffness of neck 3. headache 4. n/v 5. altered LOC 6. restlessness 7. irritability 8. photophobia 9. Kernig's sign, Brudziski's sign, opisthotonos
Kernig's sign inability to extend the leg when the thigh is flexed on the abdomen without extreme pain
Brudziski's sign flexion of the neck produces flexion of the hips and knees
opisthotonos an extreme hyperextension of the neck and arching of the back
medical management of meningitis 1. antibiotics 2. anticonvulsants 3. prophylactic therapy for contacts if meningococcal meningitis 4. hyperosmolar agents 5. IV therapy
inflammation of the brain and or spinal cord (CNS) characterized by pathological changes in the gray and white matter with nerve cell encephalitis
signs and symptoms of encephalitis similar to meningitis but more gradual onset
Guillian-Barre SYndrome widespread inflammation and demyelination of the peripheral nervous system 2. exact cause unknown (thought to be viral or autoimmune) 3. starts in lower extremeties and moves up 4. motor weakness, numbness,and tinkling are first symptoms
GBS signs and symptoms 1. prgressive weakness of muscles of respiration 2. total paralysis 3. changes in BP, HR and rhythm
brain abscess 1.pus or purulent material in the brain 2. secondary infection from: middle ear, sinus, other organs and systems, surgery, trauma
s/s of brain abscess 1. paralysis 2. ICP 3. mental deterioration 4. seizures 5. visual disturbances 6. headaches
astigmatism defect in the curvature of the eyeball surface
cataract opacity/clouding of the lens
cryosurgery surgery to freeze the borders of a retinal hole with a frozen tip probe
diabetic retinopathy disorder of the retinal blood vessesl characterized by hemorrhage & microaneurisms, leading to total retinal detachment & blindness
enucleation removal of the eyeball
glaucoma elevated pressure in the eye
hyperopia farsightedness
keratitis inflammation of the cornea
keratoplasty implantation of a donor cornea
miotic substance that contracts the pupil
mydriatic substance that dilates the pupil
myopia nearsightedness
radial keratotomy surgery that uses partial thickness, radial incisions in the cornea, leaving an uncut optical center
radial detachment separation of the retina from the choroid
sjogren's syndrome decreased tear secretion and increased tear eveaporation with dry mouth
strabismus inability of the eyes to focus in the same direction
Amsler's chart used to detect defects of the macular area of the retina
exopthalmometry equipment used to measure the degree of forward placement of the eye
slit-lamp used to examine the conjunctiva, lens, vitreous humor, iris and cornea
tonometry used to measure intraocular pressure to detect tumors and glaucoma
Schmirmer tear test measures tear volume produced during a fixed time period
opthalmoscopy routine screening to evaluate the underlying structure of the eye
retinoscopy refraction through reinoscope or sample lens that measures visual acuity to determine myopia, hyperopia, presbyopia, and astigmatism
total blindness no light perception and no usable vision- considered legally blind
functional blindness the patient has some light perception but no usable vision-considered legally blind
legally blind individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight reduced by 20 degrees
clinical manifestations of blindness 1. diplopia 2. pain 3. floaters 4. light flashes 5. burning eyes 6. loss of peripheral vision 7. sense of orbital pressure 8.pruritis 9.halos
manifestation of asigmatism blurring of vision
manifestation of strabismus eye lacks symmetry
causes of blindness 1. diabetic retinopathy 2. glaucoma 3. cataracts 4. retinal degeneration 5. acute trauma
hordeolum (stye) 1.acute infection of eyelid margins or sebaceous glands of the eyelashes 2. caused by staphylococcus organisms 3. manifests as an abscess at the base of eyelashes with edema of the lid
blepharitis 1. inflammation of the eyelid margins 2. caused by bacterial infection or psoriasis, seborrhea, or allergic reaction
clinical manifestations of cataracts 1. blurred vision 2. complaints of "haze or fuzziness" 3. diplopia 4. photosensitivity 5. glare 6. difficulty driving at night 7. visual distortions
intracapsular surgery removal of the lens with its capsule
extracapsular surgery removal of the lens leaving posterior portion of its capsule (preferred)- smaller incision, less healing time
phacoemulsification most common type of extracapsular extraction, uses ultrasound to break up and remove the cataract through a small incision, thereby decreasing healing time and chance of complications
clinical manifestations of diabetic retinopathy 1. inititally identified by ophthalmoscope examination showing microaneurysms 2. later by evidence of "floaters" and vision loss
photocoagulation 1. surgical intervention of diabetic retinopathy 2. destroys new blood vessels, seals leaking vessels, and helps prevent retinal edema by use of a laser beam
vitrectomy 1. surgical intervention for diabetic retinopathy 2. removal of excess vitreous fluid and scar tissue-replacement with normal saline 3. used when photocoagulation is not possible
macular degeneration condition of aging retina characterized by slow loss of central and near vision
manifestations of macular degeneration 1. gradual loss of biateral central vision 2. color perception is affected
retinal detachment separation of the retina from the choroid in the posterior portion of the eye 2 usually results from a hole in the retina that allows vitreous humor to leak between the choroid and the retina
manifestations of retinal detachment 1. sudden or gradual development of flashes of light, floating spots 2. loss of specific field of vision 3. preogressive loss of vision to complete blindness 4. condition is painless
open-angle glaucoma 1.progressive and results in further degenerative changes 2. 90% of glaucoma 3. outflow of aqueous humor decreased in the trabecular meshwork, causing drainage channels to be blocked.
closed-angle glaucoma 1. related to abrupt angle change of the iris, causing rapid vision loss and dramatic symptoms 2. also known as narrow-angle glaucoma
beta-adrenergics (glaucoma meds) 1. reduce the formation of aqueous humor 2. used in open angle glaucoma 3. i.e. betopic, timolol 4. pregnancy, DM, heart condition precautions; keep container tightly closed
carbonic anhydrase inhibitor (glaucoma meds) 1.lowers intraocular pressure 2. open-angle 3. i.e. Diamox (acetazolamide) 4. drowsiness, monitor weight and I&O
mitotics (glaucoma meds) 1. reduce intraocular pressure 2. open-angle 3. i.e. PIlocar (pilocarpine hydrochloride) 4. use exact dose, apply light finger pressure on lacrimal sack 1 minute after instillation
anticholinergic (glaucoma meds) 1. diagnostic, dilates pupil, temorary paralysis of ciliary muscles 2.i.e. Cyclogyl (cyclopentole hydrochloride) 3. contraindicated in closed-angle glaucoma in older adults
osmotic diuretcis (glaucoma meds) 1. i.e. Mannitol 2. IV administration
Foods that might cause or worsen headaches include: 1. MSG 2. vinegar 3. chocolate 4.yogurt 5. alcohol 6. pork 7. fermented or marinated foods 8.cured sandwich meat
vascular headache suppressants include: 1. ergot derivatives 2. serotonin receptor agonist 3. beta blockers 4.miscellaneous
special considerations for ergot derivatives (i.e. Sandoz, Migranal, Cafergot) 1. may be given with caffeine, phenobarbital, and belladonna 2. containdicated in pregnant women 3. side effects- nausea, vomiting, numbness, tingling, muscle pain
why are ergot derivatives contraindicated in pregnancy? causes contractions of the uterine smooth muscle
do not use ________ in combination with ergot derivatives selective serotonin receptors
miscellaneous vascular headache suppressants 1. divalproex sodium 2. valproate sodium 3.valproic acid
intractable pain pain that is unbearable and does not respond to treatment
TENS transculateous electrical nerve stimulation
medications used for neurological pain 1. non-opioid analgesics 2. opioid analgesics 3. muscle relaxants 4. gabapentin
when is a nerve block used? intractable pain
multiple sclerosis 1. a common degenerative neurolgical disease 2. cause unknown 3. end resut is damage to the myselin sheath
clinical manifestations of MS 1. visual problems 2. urinary incontinence 3. fatigue 4. weakness or uncoordination of an extremity 5. sexual problems 6. difficulty swallowing
exacerbations of MS aggravated or precipitated by... fatigue, chilling, emotional disturbances
in MS, testing of CSF will show... elevated gamma globulin and an increased number of WBCs
What are adrenocorticotropic hormones (ACTH) and corticosteroids used for in MS? used at the start of exacerbation, and has been shown to cause a more rapid resolution of the episode
Valium, antrolene, and baclofen are _____ _____ _______ used in MS to reduce spasticity skeletal muscle relaxants
recombinant monoclonal antibodies,like natalizumab, are a new MS therapy, used to... inhibit the migration of leukocytes to decrease inflammatory response
it is important for a patient with MS to have a diet high in _____ fiber
Parkinson's disease syndrome that consists of: 1. slowing down in the initiation and execution of movement 2. increased muscle tone, tremor, and impaired postural reflexes 3. due to damage or loss of dopamine producing cells/neurons
drug therapy for Parkinson's is aimed at... increasing the levels of dopamine and/or antagonizing the effects of acetylcholine to slow the progression of the disease
benztropine mesylate (Cogentin) and trihexyphenidyl HCL 1. dopamine receptor agonsists (anticholnergic) 2. indirect acting 3. indicated in treatment of mild cases of Parkinson's disease and control of extrapyramidal reactions
amantadine HCL 1. presynaptic dopamine release enhancer 2. indirect acting 3. potentiates the action of dopamine in the CNS
bromocriptine (Parlodel) and pergolide (Permax) 1. dopaminergic 2. direct acting- stimulation of the dopamine receptors
carbidopa-levodopa (Sinemet) 1. dopaminergic 2. direct-acting 3. increases levels of dopamine and levodopamine
dopaminergics have decreased effectiveness if taken with _______ or __________ metoclopramide, phenothiazines
levodopa interacts with 1. benzodiazepines 2. haloperidol 3. tricyclic antidepressants 4. antacids 5. metoclopramide 6. pyridoxine 7. anticholinergics
pramipexole (Mirapex) and ropinirole (Requip) 1. anti-Parkinson agent 2. direct-acting- stimulation of dopamine receptors in the brain 3. they may be used alone or adjunct with levodopa
selegiline HCL (Eldepryl) 1. MAO inhibitor 2. indirect acting 3. may slow parkinson's 4. may prolong lifespan
most common side effects for anti-parkinson agents 1. involuntary movement 2. headache 3. insomnia 4. nightmares 5. orthostatic hypotension 6. palpitations 7. tachycardia 8. n/v 9. urinary hesitency/retention
diagnosis of parkinson's can be made when two of these three signs of the classic triad exist: 1. tremor 2. rigidity 3. bradykinesia
Alzheimer's disease a degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning
brain changes in Alzheimer's disease 1. plaques in the cortex and neurofibrillary tangles 2. decrease in the brain size
use of Ativan and Haldol in Alzheimer's to lessen agitation and unpredictable behavior
folic acid decreases levels of ______- homocysteine
1. donepezil (Aricept) 2. galantamine (Reminyl) 3. rivastigmine (Exelon) 4. tacrine (Cognex) cholinesterare inhibitor agents used to treat mild to moderate alzheimer's
memantine (Namenda) 1. moderate to severe 2. an-methyl-D-aspartate receptor
Created by: hegaub