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68WM6 Phs 2 test 15
68WM6 Phase 2 test 15 Nervous System
| Question | Answer |
|---|---|
| Welcome to test block 15... | LET'S DO THIS!! |
| what are some changes in aging r/t your brain? | loss of brain weight and neurons, altered sleep/awake ratio, decreased in nerve impulses, decreased ability to control body temp, decreased blood supply to spinal cord resulting-decreased reflexes |
| T/F: short-term memory is more affected than long-term memory r/t aging. | True |
| what are some things you want to know about the patient r/t a neuro assessment r/t aging? | headaches, clumsiness, changes in vision, seizure activity, pain/numbness, personality/mood changes, fatigue/tiredness |
| r/t mental status, what are some things you look for in your assessment? | A&O X 3?, mood/behavior, general knowledge(U.S. Presidents), short and long term memory, attention span, ability to concentrate |
| Arousal: | responsiveness to auditory, visual, and tactile stimuli |
| Awareness: | reflected in orientation to person, place, and time |
| levels of consciousness | Alert, Disorientation, Stupor, Semicomatose, Comatose |
| What are the first signs of increased intracranial pressure | Restlessness, lethargy and disorientation |
| Aphasia | language function is defective or absent |
| Dysarthria | difficult poorly articulated speech |
| look for these when assessing motor function: | Gait, Coordination, Weakness (flaccid), Reflexes, Posture, Involuntary movements (spastic), Paralysis vs Paresis |
| Crainial Nerve (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 |
| which CN's are associated with your eyes? | III, IV, VI |
| CN V | (trigeminal) Jaw strength, facial sensation, corneal reflex |
| CN VI | (abducens) tested with CN III - lateral eye movements |
| 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 |
| Basic nursing considerations r/t a CT Scan | 30-60 mins of lying still IV line started if contrast medium planned Claustrophobia Allergy to iodine/seafood significant |
| Basic nusing considerations r/t Brain Scan/Echoencephalogram: | 45 mins time IV line |
| Basic nursing considerations r/t an MRI | Remove watches, jewelry, any metal from clothing Questioned about metal in the body Noise |
| Basic nursing considerations r/t a PET: | IV line 45 mins lying still |
| Basic nursing considerations r/t a lumbar puncture: | 10-15 mins Slight pain and pressure Sharp shooting pain down one leg common Patient positioning on side with knee and head flexed Slight bleeding at site Patient to lie flat for several hours after to avoid headaches |
| Basic nursing considerations r/t a Electroencephalography (EEG) | Patient must be quiet and rest before procedure One hour to complete Hair and scalp to be clean Wash hair after to remove electrode paste Must rest after procedure |
| Basic nursing considerations r/t a Myelogram | 2 hours to complete Slight discomfort during procedure May need to assume variety of positions IV & check for allergies to contrast agents CT scan to follow Headache, nausea, vomiting common after Patient must rest after for a few hours |
| Basic nursing considerations r/t an Angiography (Pre/intraprocedure) | Oral intact restricted- NPO or clear fluids Check for allergy to iodine VS and neurological checks done 2-3 hours to complete Discomfort in lying still that long Hot flush feeling when dye injected Bedrest ordered after procedure |
| Basic nursing considerations r/t an Angiography (Post procedure) | Bedrest ordered after procedure Patient assessed routinely for VS, neuro checks, LOC, puncture site High risk for CVA and/or Increased Intracranial Pressure (IIP) after procedure |
| Carotid Duplex | Noninvasive probe on skin and moved along carotid |
| Basic nursing considerations r/t an Electromyography | 45 mins to complete Discomfort when electrode inserted and when electrical current is used Muscle ache after procedure Assess for signs of bleeding Provide analgesia |
| Same as a brain scan | Echoencephalogram |
| Potential Nursing Diagnoses r/t neuro exams | Knowledge deficit related to procedure Anxiety related to procedure Alteration in comfort related to procedure |
| Caused by degeneration of or pressure on the fifth cranial nerve | Trigeminal Neuralgia |
| Also known as Tic douloureux Usually affects persons in middle or late adulthood Slightly more common in women | Trigeminal Neuralgia |
| Characterized by excruciating, knifelike, or lightinglike shock in the lips, upper or lower gums, cheek, forehead, or side of nose | Trigeminal Neuralgia |
| Clinical Manifestations of trigeminal neuralgia | The pain radiates along one or more of the three divisions of the fifth cranial nerve, Pain typically extends only to the midline of the face and head, The sensory (afferent) branches are most commonly affected |
| what are some trigger points for trigeminal neuralgia? | chewing toothbrushing, washing face talking, yawning, hot/cold breeze on face |
| medication r/t trigeminal neuralgia | Tegretol (Carbamazepine) Dilantin (Phenytoin) Depakene (Valproate) Neurontin (Gabapentin) |
| High doses of corticosterioids = | glucose monitoring! Will increase glucose levels requiring possible insulin drip |
| Within 24 hours after a 5th nerve resection, many develop ____ ____ of the lips. | herpes simplex |
| ______ _____ may be injected into the peripheral branches of the trigeminal nerve | Absolute alcohol |
| what are some nursing interventions r/t trigeminal neuralgia | Keep room free of drafts, avoid walking briskly at bedside of patient Place bed out of traffic area-prevent jarring of bed don't touch pt’s face Don't urge pts wash/shave or to comb the hair Avoid hot/cold liquids, Puree food/lukewarm, use a straw |
| Is thought to be caused by an inflammatory process involving the facial nerve (VII) | Bell’s Palsy (Peripheral Facial Paralysis) |
| r/t Bell's Palsy, evidence that reactivated ___ ___ ___ may be involved in the majority of cases | herpes simplex virus (HSV) |
| what does the reactivation of herpes simplex cause r/t Bell's Palsy? | The reactivation of the HSV causes inflammation, edema, ischemia, and eventual demyelination of the facial nerve VII |
| Etiology & Pathophysiology r/t Bell's Palsy? | This causes pain and disturbances in motor and sensory function May affect any of the three branches of the facial nerve Disorder can be unilateral or bilateral |
| clinical manefistations r/t bell's palsy | abrupt onset of numbness or a feeling of stiffness or drawing sensation of the face Unilateral weakness of the facial muscles is most common, inability to wrinkle the forehead, close the eyelid, pucker the lips, or retract the mouth on that side |
| other s/s of Bell's Palsy | Loss of taste Reduction of saliva on affected side Pain behind the ear Ringing in ear or other hearing loss |
| medical management for Bell's Palsy | Electrical stimulation or warm moist heat along the course of the nerve may help Corticosteroids: especially Prednisone are started immediately-best results are obtained if initiated before paralysis is complete |
| medications r/r Bell's Palsy | acyclovir Valtrex famvir Alone or in conjunction with prednisone |
| ___ ___ ___is implicated in about 70% of cases Bell’s palsy | Herpes simplex virus |
| nursing interventions r/t Bell's Palsy | protect eyes with patch, eye drops, massage affected area, exercise face TID for 5 min-ish- wrinkle forhead, close eyes, puff cheeks |
| _____ is usually the first sign of improvement r/t Bell's Palsy | Taste |
| Brain tumors are named for? | the tissues from which they arise: Gliomas Meningiomas Pituitary Tumors Neuromas |
| subjective data r/t brain tumors: | unusual odors, hearing loss, headaches, abnormal visual problems, inability to carry out daily activities |
| objective data r/t brain tumors: | LOC, A&O, speech abnormalities, s/s of ICP, motor strength & gait |
| __ ___ is often the basis for the diagnosis of brain tumor | CT scan |
| Craniotomy | surgical opening through the skull. the bone is removed and carefully preserved replaced at the end of surgery if there is no indication of infection or increased intracranial pressure |
| Craniectomy | surgical removal of part of the skull without replacing it |
| medical management for brain tumors. Also, determined by? | Radiation, Chemotherapy. Choice of therapy is determined by: Tumor site Tumor type |
| medications r/t brain tumor | to control increased intracranial pressure: Osmotic diuretics/hyperosmolar drugs Corticosteriods Anticonvulsants are given to prevent seizures Dilantin - Cerebyx Opioids and other drugs that cause respiratory depression are used sparingly |
| nursing considerations r/t brain tumors | baseline neurological assessment, hair is shaved, Prepare family for patient’s appearance |
| Nursing Diagnosis and Interventions r/t brain tumors | Communication, impaired verbal, related to ischemic injury, speak slowly, yes or no questions, begin speech therapy |
| Nursing Diagnosis and Interventions r/t brain tumors | Nutrition, imbalanced: less than body requirements, related to impaired ability to swallow, Position patient with head elevated and turned to unaffected side, foods initially that are easier to swallow |
| Second most common cause of neurological injury, Major cause of death between ages 1 and 35 | craniocerebral trauma |
| causes of head injuries | MVA’s Falls Sports Industrial accidents Assaults |
| what are the types of open head injuries? | Linear Comminuted Depressed Compound Fractures at the base of the skull are more serious |
| incomplete break, typical line | Linear |
| results from blunt trauma to a flat bone causing an indentation | depressed |
| the bone is shattered into two or more fragments | comminuted |
| 3 types of closed head injuries | laceration, concussion, contusion |
| violent jarring or shaking that results in a disturbance of brain function | concussion |
| damage to brain tissue and nerve fibers, bruising and possible hemorrhage, bruising at site of injury or opposite side | contusion |
| Results from hemorrhage post-craniocerebral trauma | hematoma |
| Individuals at high risk for cerebral hematomas | Receiving anticoagulants Have an underlying bleeding disorder |
| Arterial bleeding between the dura and skull,Initial unconsciousness-regains consciousness then lapses into coma, Ipsilateral pupil changes, Contralateral hemiparesis | epidural hematoma |
| Venous bleeding between the dura & subarachnoid layers | subdural hematoma |
| Progressive deterioration in LOC Ipsilateral pupil changes Decreased extraocular muscle movement Periodic episodes of memory lapse, confusion, drowsiness, and personality changes | subdural hematoma |
| intracerebral hematoma | bleeding into the brain tissue, IICP |
| s/s of IICP | LOC HA Vomiting Changes in VS Pupil Changes Posturing Nausea Abnormal sensation Rhinorrhea/Otorrhea |
| more s/s of IICP | LOC, motor status, seizures, speech, battle signs/raccoon eyes, Cushing's Triad/Response |
| Cushing’s Triad or Cushing’s Response | Late sign Increased systolic BP Widening pulse pressure Bradycardia |
| considerations r/t medical management r/t airway management r/t IICP | Do not suction via the nose, Possible ETT and ventilator, Adequate O2 levels. Control pH: Keep CO2 levels at the low end of normal, Monitor ABGs closely |
| name the devices/methods for diagnosing/detecting CSF/ICP | Detecting CSF in otorrhea and rhinorrhea drainage: Dextrostick, Halo sign. CT scan and MRI, Internal monitoring devices |
| medical management for simple skull fracture | Bed rest Observation for IICP Scalp lacerations |
| medical management for depressed skull fracture | Surgical intervention to: Remove fragments or elevate depressed bone, Repair damaged tissue and control bleeding, Antibiotics, Control IICP, Anticonvulsants to treat or prevent seizures |
| medical management for scalp lacerations | clean, debride, & suture |
| medical management for concussion | rest, Tylenol, watch for complications |
| medical management for contusion | CT/MRI, drug therapy, assist ventilations |
| medical management for hematoma | Relieve pressure, stop bleeding, or remove clot: Burr holes, Craniotomy, Craniectomy Cranioplasty. Rapid change in LOC and increase in ICP is Medical Emergency |
| medications to reduce cerebral edema and IICP | Osmotic diuretics (Mannitol) Corticosteroids (Dexamethasone |
| Anticonvulsants to treat or reduce seizures | Dilantin Cerebyx |
| nursing considerations r/t IICP | Elevate head of bed to 30-45 degrees, No Valsalva’s maneuver, Foley catheter, Perform suctioning only as necessary, Administer oxygen Use a hypothermia blanket |
| r/t headaches, pain is usually behind the forehead and/or cheekbones | sinus headache |
| r/t headaches, pain is in and around the one eye | cluster headache |
| r/t headaches, pain is like a band squeezing the head | tension headache |
| r/t headaches, pain, nausea and visual changes are typical | Migraine headache |
| r/t headaches, where does the pain come from? | Pain arises from the scalp, it’s blood vessels and muscles, and from dura matter and its venous sinuses, also from blood vessels at the base of the brain and cervical cranial nerves |
| what are some prodromal signs of a migraine? | visual field defects, disorentation, parasthesias, paralysis of part of body(rare) |
| manifestations during a migraine headache | Nausea, vomiting, Sensitivity to light, Chills, diaphoresis, Irritability, fatigue, Edema |
| contributing factors r/t migraines | Emotional stress, Excess carbohydrates, Iodine rich foods, Alcohol, Chemical additives (MSG), Fatigue, Caffeine |
| Episodic--lasting 30 minutes to 2 hours, 2 to 10 headaches per day, Pain on one side of the head usually around or behind one eye | cluster headaches |
| Pain is described as a band of pressure encircling the head typically with a steady ache | tension headache |
| causes for tension headaches | emotional stress, eyestrain, maintaining a fixed position |
| dietary foods that can cause or worsen headaches | Tyramine, nitrates or glutamates (MSG) Vinegar Chocolate Yogurt Alcohol Pork Fermented or marinated foods Cured sandwich meat |
| what are some comfort measures that can be taken r/t headaches | cold/warm packs, pressure to temporal areas, stimuli reduction, exercise, cluster care to allow good rest periods |
| meds used to tx headaches | NSAIDS, Motrin, Aspirin, Tylenol, Darvon, darvocet-N |
| Vascular Headache Suppressants | Ergot Derivatives, Serotonin Receptor Agonist, Beta-Blockers, Miscellaneous |
| directly stimulate alpha-adrenergic and serotonergic receptors, producing vascular smooth muscle and vasoconstriction | Ergot derivatives - Sandoz, Migranal, Cafergot |
| is contraindicated in pregnant women (cause contractions of the uterine smooth muscle) | Ergot derivatives |
| Side effect include nausea, vomiting, changes in heart rate, numbness, tingling and muscle pain | Ergot derivatives |
| Selective Serotonin receptor agonists | 5-HT Agonists produce vasoconstriction by acting as serotonin agonists - Imitrex- also relieves the N&V, photophobia, and sensitivity to sound; & Zolmitriptan (Zomig). |
| examples of Beta-Blockers | propranolol (Inderal). timolol (Blocadren). atenolol (tenormin) |
| pt teaching r/t headache medication | use only during migraines, lying down in a dark room, may cause dizziness, avoid alcohol |
| r/t Neurological Pain, name stimuli | cellular damage, innate chemicals, heat/cold, ischemia, muscle spasm, pruritis |
| Intractable Pain | Pain that is unbearable and does not respond to treatment |
| Neurological Pain may evolve from lesions involving | Peripheral cutaneous nerves, Sensory nerve roots, The thalamus, Central pain tract |
| what are some objective information you need during a neuro assessment | behavior changes, change in ADLs, muscle weakness, vasomotor response, altered sensory exam, abnormal spinal reflexes |
| diagnostic tests r/t neurological pain | electrical stimulation, psychological testing, myelogram |
| examples of non-surgical pain control | TENS unit, spinal cord stimulation, acupuncture, nerve block, Meds- non-opiod/opiod/muscle relaxants. counseling |
| surgical methods of pain control | Neurectomy, Rhizotomy, Cordotomy, Percutaneous cordotomy |
| Neurectomy | nerve excision |
| Rhizotomy | cut of a spinal nerve root |
| Cordotomy | cutting a nerve in the spinal cord |
| Percutaneous cordotomy | destruction of a nerve bundle by means of an electric current |
| r/t pain, The most important nursing intervention is | pt teaching |
| r/t pain, what type of diet may be ordered | High fiber diet and fluid intake to prevent consipation |
| Agnosia | The Total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage |
| what are some nursing considerations r/t intracranial tumors | maintain safe environment, protect from self-injury, speak in kind tone using short simple sentences, give one direction at a time, keep personal items in the same place |
| nursing considerations r/t neurological pain | ROM q 2-4 hrs, maintain joint mobility, positive attitude |
| ICP occurs ____ and progresses ____ | suddenly, rapidly |
| causes of ICP | space occupying lesions(tumor), trauma, CSF excess, cerebral edema |
| increased ICP = ? | reduced cerebral blood flow: inadequate perfusion, increased PaCO2, decreased pH & PaO2, vasodialation, increased edema |
| clinical manifestations of IICP | decrease LOC, pupillary dysfunction, visual abnormalities, Headache, loss of motor function, altered BP, RR, HR |
| Subjective Manifestations of IICP | Diplopia Nausea Pain especially a headache (increases with cough, straining with stool or stooping) |
| Clinical Manifestations of IICP; (Late signs-Brain stem involvement) | altered RR / temp, cushing's syndrome, papilledema, projectile vomiting, singultus |
| singultus | hiccup |
| decerebrate posture | damage to upper brain stem, arms are adducted and extended, wrists pronated, fingers flexed, legs stiff with feet plantar flexion - arms down by side |
| decorticate posture | legs stiff, arms across chest, fists made |
| what is the goal of tx r/t IICP | control the ICP and prevent further injury |
| pharmacological management of IICP | Hyperosmotic agents Sedation Phenytoin Paralytic agents |
| what is the action of Mannitol | Draw water out of brain tissue by increasing osmolality of the blood. mannitol in bloodstream pulls water from the cells into the bloodstream- does not cross blood-brain barrier |
| what other drug may be used in conjunction with Mannitol | Lasix |
| Usually wake patients up every ___ hours to assess neuro function for first few days after injury | 24 |
| Propofol (____ ____-acting agent) | very short |
| Midazolam (____ acting agent) | long |
| r/t Phenytoin, Maintain therapeutic dose for ___-___ days after injury to prevent seizures | 7-10 |
| Paralytic agents | Vecuronium, Atracurium |
| Hypercarbia | (elevated PaCO2) causes cerebral vasodilatation. |
| nursing considerations r/t IICP | HOB 30-45 degrees, prevent hyperextension/ rotation/ flexion of neck, avoid valsalva, avoid flexion of hips & waist. MUST avoid shivering |
| fasciculations | muscle twitch |
| clonus | is a series of involuntary muscular contractions and relaxations |
| Applying surface electrodes or inserting needle electrodes into a muscle to observe electrical activity | Electromyogram |
| centrally acting skeletal muscle relaxant, antispasticity agent | Baclofen |
| direct acting skeletal muscle relaxant | Dantrium |
| centrally acting skeletal muscle relaxan | Valium |
| Motor function disturbances result from? | Results from damage to the nervous system |
| Disruption in the sensory pathway from a lesion anywhere within the sensory system pathway | Alteration in Sensory and Perceptual Function |
| Proprioception | the sense of how your own limbs are oriented in space |
| Agnosia | inability to recognize and identify objects or persons despite having knowledge of the characteristics of those objects or persons |
| The onset of seizures is usually before ___ years of age, but can begin at any age | 20 |
| predisposing factors for seizures | high fever, electolyte imbalance, uremia, brain tumor, drug/alcohol withdrawal, hypoxia, trauma/injury |
| most common type of seizure. proceeded by aura, loss of LOC for several minutes, pt may fall down | tonic-clonic (grand mal) |
| post seizure activity - tonic-clonic | headache, sleep for 1-2 hours |
| this seizure usually happens during childhood and decreases in aging. Sudden impairment of LOC. NO tonic-clonic movements. Sudden blank stare, most motor activity stops. | Absence (Petit Mal) |
| Pinna or auricle | external auditory canal |
| Tinnitus | a subjective noise sensation heard in one or both ears; ringing or tinkling sounds in the ear |
| the sensation that the outer world is revolving about oneself or that one is moving in space | Vertigo |
| test is performed by placing the stem of a vibrating tuning fork in the center of the patient's forehead or on the maxillary incisors | Weber's test |
| 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, allergy or tumor that collects in the middle ear as a result of obstruction of the auditory tube |
| Labyrinthitis | an inflammation of the labyrinthine canals of the inner ear |
| a condition characterized by chronic progressive deafness caused by the formation of spongy bone, with resulting ankylosis of the stapes, causing tinnitus and then deafness | Otosclerosis |
| disturbance of the semicircular canals that results in tinnitus and unilateral deafness | Meniere's Disease |
| 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 | Deterioration of the nerve fibers and breakdown of the cells in the organ of Corti, Loss of ability to hear high frequencies and to distinguish consonant sounds |
| Rinne test | performed with tuning forks placed 0.5 inch from the external auditory meatus and the vibrating stem placed over the mastoid bone |
| In sensorineural loss, the sound is heard longer by ____ _____. | air conduction |
| In conduction hearing loss, the sound is heard longer by ____ ____. | bone conduction |
| Romberg test | measures the patient's ability to perform specific tasks with eyes open and then with eyes closed |
| Caused by any disease or injury that interferes with conduction of sound waves to the inner ear | Conductive hearing loss |
| Vestibular testing | measures balance and equilibrium |
| tx for conductive hearing loss | Removal of excess cerumen from external acoustic meatus, Surgery to restore the ability of ossicles to vibrate, Use of hearing aid |
| Sensorineural hearing loss (nerve deafness) | Results from malfunction of the inner ear, vestibulocochlear nerve, or auditory center of the brain |
| causes for Sensorineural hearing loss | arteriosclerosis, tumor of the 8th cranial nerve, infections, ototoxic drugs and prolonged exposure to loud noises |
| Functional hearing loss | has no organic cause |
| Central hearing loss | occurs when the auditory pathways in the brain are damages such as in a stroke |
| Congenital hearing loss | present from birth or early infancy,and may be the result of anoxia or trauma during the delivery |
| causes for congenital hearing loss | Rh incompatability, mother’s exposure to syphilis or rubella during pregnancy, Use of ototoxic drugs during pregnancy. |
| In conductive hearing loss, r/t the Weber test the sound is ____ in the affected ear; with the Rinne test sounds transmitted through ___are heard longer than or equal to sounds through ____ | louder; bone, air |
| In Sensorineural hearing loss, r/t to the Weber test, the sound is louder in the _____ ear and r/t the Rinne test, ____-conducted sounds are heard longer than ____-conducted sounds | unaffected, air, bone |
| The most common cause of otitis externa | contact with contaminated water |
| medical management for otitis externa | oral analgesics, corticosteroids, antibiotics/antifungal agents |
| fetid | Nasty smelling...ewww |
| Fluid collects in the middle ear as a result of obstruction of the auditory (eustachian) tube | otitis media |
| causes of otitis media | infection, allergy, tumors, upper resp infection-organism moves from Eustachian tube to middle ear, collection of pus in middle ear |
| clinical manifestations of otitis media | feeling of fullness in ear, some hearing loss, severe deep throbbing pain, tinnitus, fever |
| medical management for otitis media | antibiotics, myringotomy, analgesics, sedatives, heat, needle aspiration, decongestants |
| An inflammation of the labyrinthine canals of the inner ear | Labyrinthitis |
| common cause of Labyrinthitis | viral upper resp infection that spreads to inner ear, certain drugs/food, tobacco/alcohol |
| s/s of Labyrinthitis | severe and sudden vertigo, N/V, nystagmus(jerking eye movements), photophobia, headache, ataxic gait |
| diagnostic tests for labyrinthitis | Electronystagmography Audiometric testing |
| medical management for labyrinthitis | Usually antibiotics and dimenhydrinate or meclizine HCL for vertigo are prescribed |
| characterized by chronic progressive deafness caused by the formation of spongy bone, with resulting ankylosis of the stapes, causing tinnitus and then deafness | Otosclerosis |
| Gradual replacement of normal bone in the otic capsula by highly vascular otosclerotic bone occurs | Otosclerosis |
| r/t Otosclerosis, ____ are twice as often affected as ___ | women, men |
| Clinical manifestations of otosclerosis | hearing loss, low-medium pitched tinnitus, deafness between age 11-20 |
| Schwartz's sign | (pink blush) may be seen through the ear indicating a high degree of vascularity in active otosclerotic bone |
| Stapedectomy | (removal of the staples of the middle ear and insertion of a graft and prosthesis) to restore hearing |
| A disturbance of the semucircular canals | Meniere's Disease |
| Meniere's Disease is most common in who? | Most common in women 30 to 60 years of age |
| medical management for Meniere's Disease | fluid restriction, diuretics, low-salt diet, tx allergies, possible surgical procedure |
| 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 vessels | CVA |
| ages most affected by CVA | 75-85 |
| strokes are either | ischemic or hemorrhagic |
| ischemic strokes = | thrombotic or embolic |
| risk factors for thrombotic stroke | use of oral contraceptives coagulation disorders polycythemia vera Arteritis chronic hypoxia Dehydration |
| describe s/s of ischemic stroke | symptoms occur during sleep or soon after rising, and get worse a few hours after wakening. They peak within 72 hours |
| causes of embolic stroke | cause by Rheumatic heart disease, Mitral stenosis, Atrial Fibrillation, MI, valvular prostheses or infective endocarditis |
| less common causes of embolic stroke | Less common causes include, air emboli, fat emboli from long bone (femur) fractures, amniotic fluid emboli (after childbirth) and tumors |
| Common causes of hemorrhagic strokes | Hemorrhagic disease(leukemia, aplastic anemia) Severe hypertension, Brain tumors, Aneurysm |
| Third most common cause of strokes | Hemorrhagic Strokes: Intracerebral-bleeding into the brain tissue, Intracranial-bleeding into the subarachnoid space |
| 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 vary in severity | Transient Ischemic Attack (TIA) |
| Most common deficit of a TIA | Contralateral weakness of the lower face, hands, arms, and legs Transient dysphasia Some sensory impairment Loss of vision, inability to speak |
| Risk factors of having a stroke | Medical conditions Hypertension Atherosclerosis Cardiac disease Diabetes mellitus Kidney disease Peripheral vascular diseaseCigarette smoking high serum cholesterol Stress Cocaine use Sedentary lifestyle Oral contraceptives Obesity |
| s/s of stroke | Hemiparesis or hemiplegia Change in LOC Signs of increased ICP Respiratory problems Presence of aphasia or dysphagia Impaired coordination Auscultate the carotid artery for a bruit |
| Expressive aphasia | -inability to speak |
| Receptive aphasia | -inability to understand written or spoken language |
| Hemianopia | visual field defect - inability to see the right (left sided stroke)or left(right sided stroke) half of an image |
| r/t diagnostic tests; ___ and ___ will reveal changes in density and differentiate between infarction or hemorrhage | CT an MRI |
| r/t diagnostic testing; indicate size of blood vessels and direction of blood flow | Ultrasonography |
| Anticoagulation therapy is used in patients with ____ stroke | thrombolytic stroke |
| Anticoagulation therapy is contraindicated in | hemorrhagic stroke |
| The most commonly used drug for thrombolytic therapy is | tissue plasminogen activator (tPA) |
| medical tx for stroke includes tPA for first ___hours then what? | 24; Heparin Coumadin Lovenox |
| Platelet antiaggregation medications | ASA Dipyridamole (Persantine) Ticlopidine (Ticlid) Clopidrogel (Plavix) |
| medical tx for hemorrhagic stroke | Evacuate the clot, Aneurysm clipped or tied off |
| ____ ____may be prescribed to reduce IICP | Dexamethasone (Decadron) |
| what additional medications may be ordered r/t tx for a stroke? | vasodialators, osmotic diuretics, Suppositories, stool softness, laxatives, or enemas |
| surgical tx for stroke and aneurysm | Carotid endarterectomy, Crainiotomy, Transluminal angioplasty |
| how often would you do a neuro assessment of your patien? | at least once a shift |
| Behavior patterns to prevent the recurrence of symptoms of stroke | Taking prescribed medications Stop smoking Reducing day-to-day stress Modifying diet |
| What is the most common cause of cerebral thrombois? | Atherosclerosis |
| injury to CERVICAL areas C5, C6, and C7 will probably result in | tetraplegic |
| injury to the junction of the thoracic and lumbar vertebrae T12-L1 or sacral segments | paraplegic |
| seen with rapid deceleration injuries, whiplash will cause what type of injury | flexion/extenison injury |
| twisting of the spinal cord; injury is called | flexion rotation injury |
| All voluntary movement below the level of injury is lost | Complete or total transection |
| cervical = | tetraplegic |
| below level of T1 | paraplegic |
| s/s of Spinal Shock | vasodialation, decreased BP/Resp, bradycardia, bowel and bladder retention, body temp, no perspiration below injury |
| poikilothermia | body temperature of the environment, unable to control body temp |
| clinical signs of autonomic dysreflexia | Severe Bradycardia Hypertension (systolic pressure up to 300mm Hg) Severe pounding headache Flushed skin with gooseflesh (Piloerection) Blurred vision, dilated pupils Anxiety Nausea Nasal stuffiness |
| predisposing factors for autonomic dysreflexia | Skin pressure or breakdown Overstretched muscles Sexual intercourse Labor and delivery Sunburn below the cord injury Infected ingrown toenail Exposure to hot or cold environmental temperature Taking over-the-counter decongestants full bladder |
| r/t autonomic dysreflexia administer ___ ___ agents and ____ if ordered | ganglionic blocking; vasodilators (Nipride) |
| C1-C3 injury | Movement in neck and above, Loss of innervations to diaphragm Absence of independent respiratory function Often fatal |
| Above C4 injury | Tetraplegia-- complete dependence Sensation and movement in neck and above May be able to breathe without a ventilator |
| C4/C5 injury | Some shoulder movement possible require respiratory support C5—full neck, partial shoulder, back, biceps; gross elbow Inability to roll over or use hands decreased respiratory reserve |
| C6/C7/C8 injury | incomplete quadriplegia Some elbow, arm and wrist movement No sensation below midchest |
| C6 injury | Shoulder and upper back abduction and rotation at shoulder, Full biceps to elbow flexion, wrist extension, weak grasp of thumb, Decreased respiratory reserve |
| C7-C8 injury | All triceps to elbow extension, finger extensors and flexors Good grasp with some decreased strength Decreased respiratory reserve |
| T1-T6 injury | paralysis below the waist with control of hands abdominal breathing Full innervations of upper extremities & back full hand strength and dexterity of grasp: Decreased trunk stability |
| T7-T12 injury | varying degrees of trunk and abdominal control Functional intercostals increased respiratory reserve |
| L 1-2 injury | Hip abduction impaired No sensation below lower abdomen |
| L 3-5 injury | Knee and ankle movement impaired, No sensation below upper thigh |
| S 1-5 injury | bowel/bladder dysfunction, variable motor and sensory loss in lower extremities and perineum |
| ___ ___ is used to change the patient's position without changing alignment | A turning frame (Stryker or Foster) |
| r/t cervical traction, what would you clean the pins with? | usually with normal saline and hydrogen peroxide |
| burr holes needed or not needed - Gardner-wells tongs | Not needed |
| sudden excessive uncontrolled electrical discharge of neurons resulting in a change of LOC | seizure |
| clinical signs of a psychomotor seizure | aura w/complex hallucination or illusions, Postictal period manifested by confusion, amnesia, and a need for sleep |
| Spasms of musculature that begin in a certain area of the body and move throughout a portion or all of the body; commonly begins in hand, foot or face and may end in a grand mal seizure | Jacksonian seizure (local / partial) |
| May antedate grand mal by months or years. May be very mild or have rapid forceful movements, Clinical signs include a sudden involuntary contraction of a muscle group, usually in extremity and no LOC, no aura/post period | Myoclonic seizure |
| This type of seizure is uncommon and characterized by a peculiar generalized tonelessness | Akinetic seizure |
| methods to diagnose seizures | Patient history Electroencephalogram (EEG) Brain scan |
| Patients without seizures after ___ to ___ years can frequently be safely removed from medication or have the dosage reduced | 1 to 2 |
| indications for surgical intervention r/t seizure patients | Brain tumors Brain abscesses Cysts Cortical scars due to cerebral trauma/birth injuries Treatment with drugs has been ineffective Intractable convulsive attacks with hemiplegia |
| give seizure meds with ___ or ___ to decrease gastric upset | milk or food |
| nursing interventions r/t seizures | balanced diet, medical ID tag, no alcohol use, frequent oral hygiene |
| what should the nurse do DURING a seizure | turned on their side, remove anything that could impead breathing, loosen restrictive clothing, protect but do not restrict patient movement |
| care AFTER a seizure | keep bed FLAT, turn pt onto side, dim lights, keep room quiet, loosen restrictive clothing |
| assessment DURING seizure | First thing a patient does Type of movement of body parts involved Parts involved Size of both pupils Incontinence of urine or feces Duration of each phase of the attack |
| Inflammation of the meninges; Causes may be bacterial, viral, or fungal | Meningitis |
| s/s of meningitis | Fever Pain and stiffness of neck (Nuchal rigidity) Headache N/V Altered LOC Restlessness Irritability Photophobia Kernig's sign Brudzinski’s sign Opisthotonos |
| Brudziski’s Sign | Flexion of the neck produces flexion of the hips and knees |
| Kernig’s Sign | Inability to extend the leg when the thigh is flexed on the abdomen without extreme pain |
| Opisthotonos | An extreme hyperextension of the neck and arching of the back |
| medical management r/t meningitis | Antibiotics PCN, Ampicillin, Rocephin, Claforan Need to penetrate blood brain barrier Given IV or intrathecal Anticonvulsants |
| nursing interventions r/t meninigitis | monitor resp status, suction ONLY if ordered by MD, elevate HOB, isolate pt |
| nursing interventions r/t meninigitis | Strict I&Os IV fluids and/or TPN therapy Turn patient Q2hrs Prevent foot drop Pain control Promote quite environment, dim lights ROM Discharge Instructions |
| Encephalitis | Inflammation of the brain and or spinal cord (central nervous system) characterized by pathological changes in the gray and white matter with nerve cell destruction |
| Encephalitis Etiology | caused by bacteria, fungi or viruses, More prevalent after influenza epidemics May follow vaccination or viral infection such as measles, chicken pox, or mumps |
| Poisoning by drugs and chemicals may mimic encephalitis such as | such as lead, arsenic, or carbon monoxide |
| ____ could be prescribed to provide pain control w/o depressing resp function r/t spinal cord injuries. | codeine |
| where would you give an injection to someone with any level of paralysis and why? | above area of paralysis; poor blood circulation and inability to feel possible complications |
| This medication depresses abnormal neuronal discharges in the CNS that may result in seizures | anti-convulsants |
| Anti-convulsants Prevent the spread of seizure activity by: | depressing the motor cortex raising seizure threshold, or altering levels of neurotransmitters, depending on the agent |
| 4 main categories of anti-convulsants | Barbiturates. Benzodiazepines. Hydantoins. Valproates. |
| examples of Barbiturates | pentobarbital (Nembutal). phenobarbital (Luminal |
| use of barbituarates | generalized tonic-clonic (grand mal), partial, febrile seizures in children |
| examples of Benzodiazepines: | clonazepam (Clonopin), clorazepate (Gen-XENE, Tranxene, Tranxene-SD), diazepam (Valium) |
| examples of Hydantoins: | fosphenytoin (Cerebyx), phenytoin (Dilantin, diphenylhydantoin, DPH, Phenytek) |
| examples of Valproates: | divalproex sodium (Depakote, Depakote ER). valproate sodium (Depacon). valproic acid (Depakene). |
| what are some misc anti-convulsant drugs: | carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal),zonisamide (Zonegran), topiramate (Topamax),(Keppra),(Trileptic) |
| Oral forms of valproic acid should or should not be given with milk? | should not |
| Anticonvulsant therapy usually is started with A(n)__________agent that acts in different regions of the brain to decrease seizure activity | single, non-sedating |
| The actions of anticonvulsants are to _______ the seizure threshold, thereby regulating neuronal firing within the brain | increase |
| complications of meningitis | Damage to cranial nerves Cerebral edema Coma Seizure disorder Brain abscess |
| s/s of encephalitis | HA, fever, stiff neck, N&V, irritability, photophobia, Tremor, uncoordination and muscular weakness Spastic or flaccid paralysi, Convulsions and shock |
| examples of medical management r/t encephalitis | Mannitol Corticosteroids IV therapy Ventilator support ET, tracheostomy, Tube feeding Relieve muscle spasms |
| if herpes simplex is the cause for encephalitis, what meds would you expect? | anti-virals, acyclovir, Vidarabine (Vira-A) |
| complications of encephalitis | Cerebral edema/ IICP Paralysis Seizures Respiratory failure Shock Parkinsonian symptoms |
| nursing interventions r/t encephalitis | Client specific Airway patency Vital signs LOC Nutritional status Skin care |
| what are some long-term complications r/t encephalitis? | memory impairment epilepsy anosmia personality changes behavioral abnormalities dysphagia |
| Guillian-Barre Syndrome (GBS) | Results in widespread inflammation and demyelination of the peripheral nervous system |
| what are the 1st s/s of GBS? Describe the path these s/s take in the body. | motor weakness & numbness, and tingling. Start in lower body and work their way up = total paralysis |
| in a lumbar puncture r/t GBS, what could you expect the results to show? | elevated protein levels in CSF |
| medical management r/t GBS | Supportive depending on symptoms and how far up the body the paralysis has moved: ventilator, TPN, corticosteriods, plasmapheresis |
| Pus or purulent material in the brain | Brain Abscess |
| what causes a brain abscess? | Secondary infection from: Middle ear Sinus Other organs and systems Surgery Trauma |
| s/s of brain abscess | Paralysis ICP Mental deterioration Seizures Visual disturbances Headaches |
| nursing considerations r/t brain abscess | Assess client for specific needs Airway patency Vital signs LOC Nutrition Skin care |
| Astigmatism | defect in the curvature of the eyeball surface, irregularly shaped cornea |
| Cataract | opacity/clouding of the lens |
| Conjunctivitis | inflammation of the conjunctiva |
| Cryosurgery | surgery to freeze the borders of a retinal hole with a frozen-tip probe |
| Diabetic retinopathy | disorder of the retinal blood vessels characterized by hemorrhage & microaneurisms, leading to total retinal detachment & blindness |
| Enucleation | removal of the eyeball |
| Exopthalmos | protrusion of the eyeball |
| Glaucoma | elevated pressure in the eye |
| Hyperopia | farsightedness |
| Keratitis | inflammation of the cornea resulting from Injury, irritants, allergies, viral infections, congenital syphilis, or smallpox, dirty contact lens |
| 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 |
| Retinal detachment | separation of the retina from the choroid |
| Sjogren’s syndrome | decreased tear secretion and increased tear evaporation with dry mouth |
| Snellen’s test | assessment of visual acuity-letter chart |
| Stapedectomy | removal of the stapes from the inner ear and insertion of the graft and prosthesis |
| Strabismus | inability of the eyes to focus in the same direction b/c of imbalance of the eye muscles; Commonly called “cross eyed” |
| what are some changes of the eye r/t aging? | lens hardens and becomes too large for the eye muscles, decreased accommodation, pupils become smaller-requires more light to see, decreased color perception, floaters, decreased depth perception, decreased amount of tears |
| what are some things you look for/ask about during an eye assessment? | pain, pruritis, floaters, light flashes, blind spots, visual changes, dryness, allergies, glasses/contacts, halo around lights |
| how far does the patient stand from the Snellen eye chart during an exam? | 20 feet |
| 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 & 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 retinoscope or sample lens that measures visual acuity to determine myopia, hyperopia, presbyopia & astigmatism |
| Total blindness | No light perception and no usable vision |
| Functional Blindness | the patient has some light perception but no usable vision |
| Legally Blind | Individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual filed sight reduced by 20 degrees |
| what are some things that cause Acquired Blindness? | results from diabetes retinopathy, glaucoma, retinal degeneration, and acute trauma, and cataracts |
| Most common clinical manifestations for Blindness & Near Blindness | Diplopia Pain Floaters Light flashes Burning eyes Loss of peripheral vision Pruritis Bulging eyes Halos Lack of symmetry of an eye structure |
| what is the primary focus of a nurse r/t a pt with blindness or near blindness? | Assist with ADL's - #1. alter surroundings to promote safety, arrange room 1 time only, encourage pt to touch things, allow adequate time for pt to adjust |
| describe the guidelines for talking to a blind person | talk in a normal tone, always introduce yourself, describe activities, announce when you leave the room, avoid stupid sayings "see what I mean?" |
| This is gonna be the longest lecture ever! Guess the instructor.... | I'm just saying...DANG! |
| name safety considerations r/t walking r/t a blind patient | walk slowly, encourage pt to touch objects, companion should preceed pt by 1 foot, patient's hand should be on companion's elbow |
| Occurs when light rays cannon be focused clearly on a point on the retina b/c the spherical curve of the cornea is not equal in all meridians | Astigmatism |
| Esotropia | eye turns toward nose - r/t strabismus |
| Exotropia | eye turns outward - r/t strabismus |
| elongation of the eyeball, refractory error focuses light in front of the retina | Myopia |
| Hyperopia | Refractory error where rays of light entering the eye are brought into focus behind of the retina |
| what can you do with a child with strabismus r/t helping the bad eye? | place a patch over the good eye, causes the bad eye to focus |
| how many days prior to corrective surgery would you tell your patient NOT to wear contacts? | 2 days prior |
| Acute infection of eyelid margins or sebaceous glands of the eyelashes; abscess at base of eyelashes w/ edema of the lid | Hordeolum |
| inflammation of eyelid margins | Blepharitis |
| an Ulcerative Blepharitis is caused by | bacterial infection; staphylococcus organisms |
| a Non-ulcerative blepharitis is caused by | Psoriasis, seborrhea or allergic reaction |
| medical management for blepharitis and Hordeolum | Anti-infective agents as prescribed Incision and Drainage of stye NS compresses 10-20 min, 2-4 q day No more tears shampoo to cleanse lids |
| what is the most common transmitter of conjunctivitis? | Yo hands! Wash yo dirty hands! |
| what seperates Keratitis from other inflammatory eye disorders? | Severe eye pain is the most common symptom |
| medical management r/t Keratitis | Topical & systemic antibiotic therapy Cycloplegia-mydriatic & analgesic drugs Pressure dressings, Epithelial debridement of loose tissues |
| Drug Use: Treatment of ocular infections | Sulamyd (Sulfacetamide sodium) |
| Drug Use: tx blepharitis and conjunctivitis | Garamycin (Gentamycin sulfate) |
| Steroid: Drug Use for inflammations only r/t ocular inflammation | Decadron (Dexamethasone) |
| Keratoconjunctivitis sicca is caused by | a lacrimal gland disorder from an autoimmune disorder |
| Keratoconjunctivitis sicca associated with dry mouth is called | Sjogren’s syndrome |
| Schirmer’s test (measures tear volume)describe | One end of strip of filter paper is placed in lower cul-de-sac; area of tear saturation is measured after 5 min; normal result is 10-15mm wet paper |
| Drug Use: dry eyes and eye irritations | Liquifilm Forte (Polyvintyl) |
| Ectropion | Outward turning of the eyelid; when the orbicularis oculi muscle relaxes |
| Paralytic ectropion occurs when | orbicularis muscle function is disturbed ex: Bell’s Palsy |
| Endotropion | Inward turning of the eyelid Caused by atrophy of the eyelid tissue, spasms of the orbicularis oculi muscle, or scarring of the tarsal plate caused by congenital origin or trauma |
| Medical Management of noninfectious eye d/o | Removal of the scarred tissue Resection of the tarsal plate Tightening of the orbicularis oculi muscle |
| Blurred vision, diplopia, photosensitivity, glare, and difficulty driving at night; no pain; visual distortions are manifestations of?? white appearance in pupil | cataracts |
| r/t cataracts, Extracapsular | removal of the lens leaving posterior portion of its capsule (preferred) |
| Phacoemulsification | Most common type of extracapsular extraction. Uses ultrasound to break up and remove the cataract thru a small incision, thereby decreasing healing time and chance of complications |
| r/t cataracts; post-op teaching includes | Instruct pt to avoid sudden movement, heavy lifting, bending over, coughing, sneezing, straining for elimination & vomiting |
| Diabetic Retinopathy | Disorder of retinal blood vessels characterized by a series of capillary microaneurysms, hemorrhages, exudates, & creation of new blood vessels; cycle continues..they keep bursting |
| Ophthalmoscopy | Shows dilated & torturous vessels and narrowing or obliteration of the arteries; opacities, hemorrhages, and microaneurysms can be seen |
| r/t Diabetic Retinopathy; Photocoagulation | destroys new blood vessels, seals leaking vessels, and helps prevent retinal edema by use of a laser beam |
| Vitrectomy | Removal of excess vitreous fluid and scar tissue-replacement with normal saline is used when Photocoagulation is not possible |
| Macular Degeneration | Condition of aging retina characterized by slow loss of CENTRAL and near vision;. Most common cause of vision loss in people >55 years old |
| wet form of Macular Degeneration | new vessel growth in the macular region; macula is displaced, and scarred. |
| dry form of Macular Degeneration | Dry type or nonexudative or nonvascular degeneration - 90% of the cases Outer layers of the retina break down. Characteristic small yellowish hyaline deposits (drusen) form within the macula resulting in blurred vision |
| Retinal Detachment | Separation of the retina from the choroid in the posterior portion of the eye Usually results from a hole in the retina that allows vitreous humor to leak between the choroid and the retina |
| c/o flashes/floaters c/o “curtain drawn over the eye” (if the tear is acute and extensive) c/o progressive vision restriction in one area | Retinal Detachment |
| an extraocular surgical procedure that involves indenting the globe so the pigment epithelium, choroids and sclera move toward the detached retina | Scleral buckling |
| post procedure medication for retinal detachment | Post procedure management: administer cycloplegicmydriatic & anti-infective eye drops |
| Occurs when there is an obstruction of aqueous humor drainage that increases intraocular pressure, and causes damage to the optic nerve | Glaucoma |
| Closed-angle glaucoma | r/t abrupt angle change of the iris, causing rapid vision loss & dramatic symptoms; Severe pain, nausea & vomiting, vision, reddened sclera, enlarged and fixed pupils, colored halos around lights |
| Open-angle glaucoma | no S/S in early stages Later- tunnel vision, eye pain, halos, inability to detect color, difficulty adjusting to darkness; Optic disk cupping- disk becomes wider, deeper, and paler |
| Schiotz tonometry- | to measure intraocular pressure |
| medical tx for open angle glaucoma | beta-blockers, mitotics, carbonic anhydrase inhibitors |
| Trabeculectomy | (removal of the corneoscleral tissue)-Open angled glacoma |
| Iridectomy | removes part of the iris, Restore drainage of the aqueous humor. Closed-angle glaucoma |
| open angle glaucoma Beta-adrenergics | Betopic (Betaxolol hydrochloride), Timolol (Timolol maleate) |
| open angle glaucoma Carbonic anhydrase inhibitors | Diamox (Acetazolamide) |
| open angle glaucoma Mitotics | Pilocar (Pilocarpine hydrochloride) |
| Anticholinergic: dilates pupil, temporary paralysis of Ciliary muscles | Cyclogyl (Cyclopentole hydrochoride) |
| Flush with tap water for __ to __ min with eyelids separated (ASAP- helps prevent scar formation | 15 to 20 |
| Cover one or both eyes while transporting with an eye injury? | Both |
| multiple sclerosis | the myelin sheath, which wraps around the axon, is destroyed with inflammation and scarring. |
| s/s of multiple sclerosis | wide variety; Visual problems Urinary incontinence Fatigue Weakness or uncoordination of an extremity Sexual problems such as impotence in men Difficulty swallowing: Pain is uncommon |
| Exacerbations of MS are aggravated or precipitated by | fatigue, chilling, or emotional disturbances |
| medical tx for MS | Corticosteroids: predisone (Deltasone) dexamethasone (Decadron) Adrenocorticotropic hormone (ACTH) |
| Spasticity (Skeletal Muscle Relaxants) | |
| Recombinant Monoclonal Antibody (drugs) | natalizumab (Antegren) Promising new therapy Inhibits migration of leukocytes decreasing inflammatory response |
| Immunomodulating Agents | Interferon beta-1b (Betaseron) & Interferon beta-1a (Avonex) |
| Interferon beta-1a (Avonex) | decreases the frequency of exacerbations in select patients and slows the progress of physical disability (IM) |
| Interferon beta-1b (Betaseron) | Used in ambulatory patients with relapsing-remitting MS to reduce frequency of exacerbations (SQ) |
| Antineoplastic / Immunosuppresant r/t MS | mitoxantrone (Novantrone) |
| mitoxantrone (Novantrone) | Reduces both B and T lymphocytes -IV monthly Has a lifetime does limit because of cardiac toxicity, Cannot be used for more than 2-3 years |
| (Pro-Banthine) | for urinary frequency and urgency |
| (Urecholine) | neurogenic bladder-exerts a direct antispasmodic effect on smooth muscles |
| Baclofen (Lioresal) | Reduces transmission of impulses from spinal cord to skeletal muscles |
| Side effects of Baclofen | Drowsiness, Dizziness, Disorientation Lightheadedness, Hypotension Urinary frequency Possible increase in blood glucose level |
| T/F: Hot baths need to be avoided because they often increase weakness r/t MS | True |
| A slowing down in the initiation and execution of movement (bradykinesia), Increased muscle tone (rigidity), tremor, and impaired postural reflexes; loss of the dopamine-producing cells/neurons | Parkinson's Disease |
| early signs of Parkinson's | Mild tremor, slight limp, decreased arm swing, change in handwriting |
| later signs of Parkinson's | Shuffling, propulsive gait with arms flexed Loss of postural reflexes. Slight change in speech patterns |
| other s/s of Parkinson's | Tremor -pill rolling motion Bradykinesia Rigidity & loss of postural reflexes cogwheel rigidity Masklike appearance of the face Slowed, monotonous speech Drooling Moist, oily skin Constipation Scaly, erythematous rash |
| Diagnosis Parkinson's requires two of the three parts of the classic triad; name the three triads | tremor, rigidity and bradykinesia |
| surgery to tx Parkinson's would include: | destroys portions of the brain controlling the rigidity or tremor, Deep brain stimulation, Human Fetal Dopamine Cell Transplant |
| r/t Parkinson's; drug therapy is aimed at | at increasing the levels of dopamine and/or antagonizing the effects of acetylcholine to slow the progression of the disease |
| Dopamine Receptor Agonists (Anticholinergic)-Indirect acting | benztropine mesylate (Cogentin) and trihexyphenidyl HCL (generic only-formally called Artane). |
| Presynaptic Dopamine release enhancer | amantadine HCL (Symmetrol). Interacts with anticholinergic drugs, sulfonamide antibiotics, quinidine, and thiazide diuretics |
| a degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning | Alzheimer's disease is |
| drugs to to lessen agitation and unpredictable behavior | Ativan and Haldol |
| eating foods rich in ___ ___ decreases levels of homocysteine | folic acid |
| Alzheimer's stage 1 | Mild memory lapses Difficulty in using the correct word Attention span is decreased Disinterest in surroundings Depression may occur at this time |
| Alzheimer's stage 2 | More obvious memory lapses Disorientation to time is common Loss of personal belongings is common, (making up stories) to explain the loss of memory, Loose ability to recognize familiar faces, places, and objects, get lost in familiar environment |
| Alzheimer's stage 3 | Total disorientation to person, place, and time Motor problems such as (apraxia - impairment in the ability to perform purposeful acts or to use objects properly) interferes with the ability to carry out daily functions Wandering is common |
| Alzheimer's stage IV | Severe mental and physical deterioration is present Total incontinence is common |
| Anti-Alzheimer drugs | donepezil (Aricept). galantamine (Reminy). rivastigmine (Exelon). tacrine (Cognex) |
| 1st drug to tx moderate and severe Alzheimer's | Memantine (Namenda) |
| Diet and nursing considerations for Memantine (Namenda) | Administer in the evening just before going to bed. May be taken without regard for food. |
| Donepezil is used to | to treat the mild-to-moderate dementia of Alzheimer’s disease and may improve the symptoms of the disease |
| A neuromuscular disorder characterized by severe weakness of one or more groups of skeletal muscles; The blocking of synaptic transmission at myoneural junction, results in muscle weakness | Myasthenia Gravis (MG) |
| Peak age of onset in young females is __ to __ years of age | 20-30 |
| s/s of MG | May initially have ptosis and /or diplopia Skeletal weakness Dysarthria Dysphagia Vocal cords weaken and the voice can sound nasal |
| r/t a stapendectomy, what post procedure position would you use? | FLAT with operative side up. Do not turn patient. |
| r/t to a typanoplasty, what vital sign is a little more impt than others? | Temperature |
| what antibiotic is used in acute otits media? | Amoxicillin |
| Trade name: Debrox, used to clean ears | Carbamide peroxide |
| what is the crazy name for the antibiotic / steroid / detergent used for susceptible disease of external auditory canal and otitis media fenestration? | colistin/myomycin/hydrocortisone/thonzonium |
| trade name antivert | meclizine hydrocholoride - antivertigo agent |
| trade name auralgan | antiphyrine/benzoaine - otits media analgesic |
| trade name: Vo Sold Hydrocholoride Otic | Acetic Acid - antibacterial, antifungal, astringent used for superficial infections of external auditory canal |
| Only block not fully completed was degenerative diseases of nervous system in volume 1. | slides not covered: 40-60; 87-121 |
| holy smokes batman!! Know your drugs. Which cause HTN, bradycardia, tachycardia, and other side effecs. | Dang! |
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jrstrader
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