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N201: Test II


Tardative dyskinsia Involuntary movement of jaw - call doctor immediately or could become permanent
CTZ Chemoreceptor trigger zone
Serotonin Agents Ondanestron (Zofran)
Serotonin Action Blocks the serotonin receptor in our brain that makes us feel nauseous when it's stimulated
Metoclopramide (Reglan) Dopamine & Prokinetic
Dopamine Antagonists Prochlorperazine (Compazine) Promethazine (Phenergan) Metoclopramide (Reglan)
Dopamine Action Blocks the dopamin receptor in our brain that makes us feel nauseous when it's stimulated
Ondanestron Zofran
Metoclopramide Reglan
Promethazine Phenergan
Prochlorperazine Compazine
Prokinetic Metoclopramide (Reglan)
Prokinetic Action Dopamine blocker Increase tone of lower esophageal sphincter Increase peristalsis
Serotonin Admin PO 30 - 40 mins. before Surgery or expected nausea
Serotonin Indications Nausea r/t pregnancy, chemo, cancer
Serotonin Side Effects Headache, Dizziness, Diarrhea
Serotonin Teaching No driving bc sedation
Dopamine Indications Prevents Nausea
Dopamine Admin PO, IV (slow-over 15 mins.), Rectal, No IV Push
Dopamine Side Effects Muscle spasms, tremors, rigidity Hypotension Sedation Dry mouth, urinary retention, constipation
Dopamine Teaching Encourage fluids Make Pt. aware of side effects
Prokinetic Indications Nausea, Vomitting, Pt's w/reflux (moves things through quickly)
Prokinetic Admin IV or PO, usually 30 mins before meals
Prokinetic Side Effects Sedation, diarrhea, dry mouth, Tardative dyskinesia
Prokinetic Teaching No alcohol or driving bc of sedation Monitor BP & hypotension
Antihistamines Dimenhydrinate (Dramamine)
Dimenhydrinate Dramamine
Antihistamine Action Blocks histamine receptors in the inner ear and CTZ - Prevents Motion Sickness
Antihistamine Indications Motion sickness
Antihistamine Admin PO, IV, IM, Rectal Give 30 mins prior to activity that causes sickness
Antihistamine Side Effects Sedation, Drowsiness, Dizziness, Dry mouth, constipation, Urinary retention
Antihistamine Teaching Teach about side effects
Antiemetics Seotonin Antagonists Dopamine Antagonists Prokinetic Antihistamines
Seotonin Antagonists Dopamine Antagonists Prokinetic Antihistamines Antiemetics
Histamine2 Receptor Agents Cimetidine (Tagamet) Famotidine (Pepcid) Ranitidine (Zantac)
Histamine2 Receptor Agents Action Block histamine receptors in stomach to decrease acid in stomach (doesn't prevent reflux but increases pH)
Histamine2 Receptor Agents Indications Reflux, Gastic & duodenum ulcers
Histamine2 Receptor Agents Admin Admin w/or w/o food, don't admin antacids w/in 1 hr. of giving antagonist (effects absorption rate) IV must be given slowly or can cause bradycardia
Histamine2 Receptor Agents Side Effects Nausea, vomiting, diarrhea, constipation Decreased WBC's (long term use) Tagamet: Seizures, Lower labido, Lethargy
Histamine2 Receptor Agents Teaching Antacids affect absorption rate of Antagonist, Smoking also interferes with absorption
Cimetidine Tagamet
Ranitidine Zantac
Famotidine Pepcid
Proton Pump Inhibitors (PPIs) Omeprazole (Prilosec) Lansoprazole (Prevacid) Pantoprazole (Protonix) Esomeprazole (Nexium)
PPI Action Decreases the acids in the stomach
PPI Indications Reflux, duodenum & gastic ulcers
PPI Admin Empty stomach, usually 1x daily before breakfast
PPI Side Effects Nausea, vomiting, diarrhea Long term use = bone loss
PPI Teaching Antacids do not affect absorption ^ Vit D ^ Ca+ ^ Exercise
Omeprazole Prilosec
Lansoprazole Prevacid
Pantoprazole Protonix
Esomeprazole Nexium
Mucosal Protectants Sucralfate (Carafate)
Sucralfate Carafate
Mucosal Protectants Action Creates gel to coat stomach (good w/pt's already have ulcer)
Mucosal Protectants Indications Pt.'s w/ Ulcers
Mucosal Protectants Admin Empty stomach - wait 2hrs before/after meals or other meds - affects absorption
Mucosal Protectants Side Effects Constipation, nausea, diarrhea, dyspepsia
Mucosal Protectants Teaching Teach pt how to take
Antacids Aluminum hydroxide (Amphojel) Calcium carbonate (Tums) Magnesium hydroxide (Milk of Magnesia)
Aluminum hydroxide Amphojel
Calcium carbonate Tums
Magnesium hydroxide Milk of Magnesia
Aluminum hydroxide Action Neutralize gastric acid
Aluminum hydroxide Indications Ulcers and reflux
Aluminum hydroxide Admin PO
Aluminum hydroxide Side Effects Amphojel & Tums: Constipation Milk of Magnesia: Diarrhea
Aluminum hydroxide Teaching Know what other medications are being taken
Decreased Blood flow + Increased stomach acid = Perfect environment for an ulcer
Prostaglandin E Analogs Misoprostol (Cytotec)
Misoprostol Cytotec
Prostaglandin E Analogs Action Works to increase pH, protect against ulcer, allow adequate blood flow to the gastric wall
Prostaglandin E Analogs Indications Prevents gastric ulcers from long-term NSAID use
Prostaglandin E Analogs Admin Take w/meals while taking NSAID
Prostaglandin E Analogs Side Effects Diarrhea, Ab pain, nausea Women: uterine cramps, spotting
Prostaglandin E Analogs Teaching Do not take if pregnant - spontaneous abortion
What drug can cause a spontaneous abortion in women if taken during pregnancy? Misoprostol
Cancer of Oral Cavity Risk Factors Alcohol/smoking Greater in Males >50yrs
Cancer of Oral Cavity Pathophysiology Lips, Tongue, Floor of mouth
Cancer of Oral Cavity Clin. Manifestations Painless lesion that doesn't heal
Cancer of Oral Cavity Diagnostic Tests Biopsy to confirm
Cancer of Oral Cavity Treatment Depends on type/extent
Cancer of Oral Cavity #1 concern Airway
A stroke is the 3rd leading cause of death in USA
Up to 80% of strokes are preventable
Strokes are the leading cause of long-term disability
_______ are more likely to have a stroke. Men
_______ are more likely to die from a stroke. Women
Cerebrovascular Disorder Any interruption of blood supply to brain causing CNS Functional abnormality
Stroke O2 supply to the brain is disrupted
Stroke has 4x higher incidence in left hemi-sphere
"STR" Can a person... Speak simple sentence? Talk? Raise both arms?
"F A S T" Facial Arms Speech Time
Neuroplasticity Neuron's ability to rearrange connections
Brain adaption brain saturated w/blood or deprived of O2 = find alt. pathways
Transient Ishemic Attack (TIA's) Cerebral ischemic event lasting < 24 hrs May even last just a few minutes No permanent neurological chgs.
Evolving Stroke Worsening of deficits over minutes Suggests widening area of ischemia
Completed Stroke Acute cerebral ischemic event w/deficits
#1 risk factor for stroke Hypertension
TIA aka "warning strokes"
Blood clot temporarily clogs artery so part of brain doesn't get blood it needs TIA
S/S of TIA Similar to stroke, usually last 1 or 2 mins.
Ischemic Stroke Obstruction of cerebral blood flow
88% of all strokes are Ischemic Stroke
"Worst headache of my life" Subarachnoid hemorrhage
Receptive Aphasia Person doesn't know what's going on
Expressive Aphasia Person knows what's going on, but can't express
Broca's Area located in Left hemisphere
Controls tongue, lips, vocal cords & ability to phonate (form words) Broca's Area
Global Aphasia Expressive & receptive aphasia
Dysphagia Difficulty swallowing
Dysarthia Impaired speech
Ataxia Gait disturbance
Nystagmus Rapid Eye Movements
Hemianesthesia Pain on one half of body that doesn't completely register
Wernicke's Area Can be in whichever hemisphere is dominant for pt.
Recalls, recognizes & interprets words & other sounds in the process of "phonating" Wernicke's Area
Dmg. to Wernicke's Area (Temporal lobe of dominant hemisphere) Inability to comprehend spoken or written words
If a Pt. is newly diagnosed with Afib, do TEE test to see if There are clots behind the heart
Trans-esophageal echocardiogram TEE test
Tissue Plasminogen Activator (tPA) Time of onset is known and < 3 hrs
Pt not a candidate for tPA if Pt is rcvg IV Heparin
Angioplasty Any endovascular procedure to reopen narrowed blood vessels & restore forward blood flow
Atherectomy Opens occluded, scarred or calcified vessels by removing atherosclerotic plaques with rapidly rotating drills
Balloon angioplasty Relies on the inflation of high-pressure balloons within blocked arteries to force open
Laser & radiofrequency waves Vaporize or ablate atheroscleroptic plaques
Endovascular stents Hold vessels open with expandable lattices inserted across narrowed section of the artery
Cerebral Angioplasty Coils surgically placed in cerebral vascular malformations to assure patency and prevent rupture (Aneurysm)
Hemorrhagic Strokes Vessel ruptures & bleeds into brain or spaces around brain
Intracerebral Hemorrhage Always hypertension related
Craniectomy Removal of part of the brain
Craniotomy Redirection - keep from getting to brain stem
Subarachnoid Hemorrhage Bleeding into subarachnoid space
Arteriovenous Malformation A tangle of blood vessels in the brain or on the surface of brain that bypasses norm brain tissue and diverts blood from arteries to the veins
Mandibular Fractures Clin. Manifestations Dull ache -> throbbing pain Restricted jaw movement
Mandibular Fractures Diagnostic X-ray or MRI
Mandibular Fractures Treatment Rigid plate fixation Bone grafting
Mandibular Fractures Nurse Mngmnt. #1 Airway #2 Nutrition
Absent/ineffective peristalsis of distal esophagus Failure of esophageal sphincter to relax in response to swallowing Achalasia
Achalasia Food cannot get into the stomach
Achalasia Diet Small frequent meals/soft/encourage fluids
Achalasia Meds Ca+ channel blockers relax sphincters
Achalasia Pneumatic dilation Balloon to try and open sphincter up
Achalasia Esophagomyotomy Enter esophagus & cut muscle fibers
90% of Hiatal Hernias are Sliding esophageal hernias
sliding Hernia Manifestations Heartburn Regurgitation Dysphasia Belching Reflux*
Reflux Occurs w/sliding hernia because Sphincter is NOT intact - food easily regurgitates into esophagus.
Paraesophageal manifestations Sense of fullness after eating Indigestion May be a symptomatic
The sphincter in a paraesophageal hernia Is still intact.
Hiatal hernia complications Strangulation
Gastroesophageal Reflux Disease (GERD) Backflow of gastric contents into esophagus
Avoid these if you have GERD High-fat diet Caffeine, tobacco, alcohol, spearmint, peppermint, carbonated bevs Eating 2 hrs before bed Tight clothing
Meds for GERD Antacids Histamine Receptor Blockers PPIs Prokinetic Agents
Treatment of GERD Nissen fundoplication
Nissen fundoplication Surgery to wrap stomach around esophagus = No reflux
Barrett's Esophagus Chgs cells in esophagus bc constant burning of lining from reflux -> pre-cancerous condition
S/S Barrett's Esophagus Same as GERD -> ppl usually don't know it's happening
Barrett's Esophagus Diagnosis Endoscopy
Barrett's Esophagus Treatment Minor cell chgs Photodynamic therapy (PDT) Prohylactic esophagectomy
Photodynamic therapy (PDT) Take out piece of esophagus & replace w/jejunum or part of stomach
Risk factors for Cancer of Esophagus Barrett's Alcohol Tobacco 3x more common in men
Cancer of Esophagus Mgmnt Radiation Chemotherapy Surgery (Esophagectomy)
Gastritis Inflamation of the stomach
Gastritis Patho Lining can become swollen & ulcerate Can cause perferation of lining = hemorrhage
Acute Gastritis Clin. Manifest Abdominal discomfort Nausea Vomiting
Chronic Gastritis Clin. Manifest Abdominal discomfort Nausea Vomiting Heart burn Pain
Chronic Gastritis Find the trigger
The most common location for ulcers is the duodenum.
Peptic Ulcer Disease Increased acid & decreased mucus allow acid to erode mucosal wall
Peptic Ulcer Disease occurs in the Stomach Pylorus Duodenum Esophagus
Increase gastric acid production Caffeine Smoking Alcohol Stress
H. pylori Bact will burrow into the lining allowing acid in to create an ulcer
H. pylori requires 2 different Ab's to cure
Intractable Ulcers Incurable Ulcers - (perform Vagotomy)
Vagotomy Cut Vagus nerve to decrease production of stomach acid - (incurable ulcers)
Antrectomy - Billroth I Take out lower portion of stomach to decrease stomach acid
"Coffee Grounds" in stomach/vomit Hemorrhage
Peritinitis Stomach leak out causing bacterial infection - sepsis
Perforation complications can lead to Peritinitis
Any leakage into the abdominal cavity... Requires Ab's
Weight indications for surgery BMI >40 or over 100 lbs overweight
3 Categories of Bariatric Procedures Malabsorptive Restrictive Combined Malabsorptive & Restrictive
Rstrictive Surgery: Reduces food intake Decrease in appetite Early satiety Control of stoma Craving control (Ghrelin)
Laparoscopic Gastric Banding Inflatable silicone band completely around upper portion of stomach
Vertical Sleeve Gastrectomy (VSG) 85% of stomach removed - shaped like small banana
Gastric Bypass Limits size of stomach and bypasses some of the small intestine
Secretory Diarrhea Bowel doesn't reabsorb water - it excretes water
Osmotic Diarrhea Pulling of water into the bowel
Infectious Diarrhea C-diff
Antidiarrheals Loperamide (Imodium) Diphenoxylate (Lomotil)
Loperamide Imodium
Diphenoxylate Lomotil
Constipation Abnormal infrequency or irregularity of defications Abnormal hardening of stools Retention of stool in rectum
Chronic Constipation <3 bowel movements/week for 12 weeks in a 12 month period
Bulk forming Laxatives Psyllium (Metamucil) Methylcellulose (Citrucel)
Psyllium Metamucil
Methylcellulose Citrucel
Bulk forming Laxative Action Promotes large soft stools by absorbing water into the intestines Stimulates peristalsis
Lubricant Laxatives Mineral oil Glycerin suppository
Lubricant Laxative Action Softens fecal matter and lubricates intestinal tract
Stimulant Laxatives Bisacodyl (Dulcolax) Senna (Senokot)
Bisacodyl Dulcolax
Senna Senokot
Stimulant Laxative Action Irritates colonic epithelium by stimulating sensory nerve ending and increasing peristalsis
Fecal softener Laxatives Docusate (Colace)
Docusate Colace
Fecal softener Laxative Action Promotes incorporation of water into the stool resulting in softer fecal mass More of daily treatment 1-5 days to take effect
Osmotic Agent Laxatives Polyethylene glycol and electrolytes
Osmotic Agent Laxative Action Rapidly pulls H2O into colon -> diarrhea out
Common Hernia Locations Inguinal Femoral Incisional Umbilical
Volvulus - Mech. Obstruction Twisting of the bowel - caused by congenital abnormality
Intussusception - Mech. Obstruction Tunneling of bowel (folds in on itself)
Paralytic illeus - Functional obstruction No blockage, lack of movement (caused by surgery)
Diverticulum Sac like pouches -> sigmoid colon, usually
Diverticulosis Multiple Diverticulum
Diverticulitis Food or infection stuck in diverticula & cause inflammation
Diverticular Disease Submucosal layers of the colon herniate through the muscular wall
Diverticular Disease Complications Peritonitis Abscess formation Fistulas Bleeding
End-to-end anastomosis Cut out bad bowel & reconnect
Appendicitis Food or infection gets lodged in the appendix
Diarrhea is common in Chrohn's Disease
In Chrohn's Disease, constipation is Occasional
Blood in stool in Chrohn's Disease is Occult Common
Abdominal pain in Chrohn's Disease is Typically mid-abdomen and right lower quadrant pain
Fever in Chrohn's Disease is Common
Weight loss/growth failure in Chrohn's Disease is Common May occur for many months to years before diagnosis
Perianal disease in Chrohn's Disease is Common for: Fistula/fissures Abscesses/skin tags
Diarrhea in Ulcerative Colitis is Common, often with urgency
Constipation in Ulcerative Colitis is Rare without obstruction
Blood in stool in Ulcerative Colitis is Very common
Abdominal pain in Ulcerative Colitis is Cramping pain, often with stools
Fever in Ulcerative Colitis is Rare
Weight loss/growth failure in Ulcerative Colitis is Rare
It is rare to have Perianal disease with Ulcerative Colitis
Chrohn's disease... often recurs after surgery
Ulcerative colitis... is curable with a colectomy
Right hemisphere right now, present pictures, sound, sight, smell
Left hemisphere past, future associate present with past to prepare future Broca's area - speech center
Broca's area Speech center, left hemisphere
Magnetic Resonance Imaging MRI
Second largest part of brain Balance and coordination, assists in controlling body movements Cerebellum
Largest most advanced part of brain higher intellect, speech, movement, emotion, and integration or sensory stimuli Cerbrum
Handles automatic functions Respiration, heart rate, BP, arousal, wakefulness & attention Brain Stem
Artistic, creative, intuitive Right hemisphere
Logic, reasoning, linear Left hemisphere
Cerebral edema any swelling of the brain
Frontal lobes Voluntary muscle movements
Parietal lobes regulate taste and touch
Temporal lobes regulate hearing & smell
Occipital lobes regulate vision
3 ways Neurological Changes may affect the body Structural Metabolic Drug Related
Cardiovascular Respiratory Infection 3 ways Neurological Changes may affect the body
AEIOU Tips = A acidosis, alcohol
AEIOU Tips = E epilepsy
AEIOU Tips = I infection
AEIOU Tips = O overdose
AEIOU Tips = U uremia
AEIOU Tips = T trauma
AEIOU Tips = i insulin
AEIOU Tips = p psychogenic
AEIOU Tips = s stroke
Often, the first sign that a neurological event is already in progress Restlessness
Progressive dilation of pupils increasing ICP
Fixed pupils very serious injury at midbrain or lower
Corneal reflex is unilateral or absent in coma
Cheyne-stokes respirations mean that lesion or injury is deep within cerebral hemispheres (death is usually imminent)
CT Scan, MRI Show displacement of brain structures
EEG studies brain's electrical activity
Cerebral angiography detects aneurysms, occluded vessels & tumors w/in cerebral arts/veins
Transcranial Doppler assesses cerebral blood flow
Lumbar puncture CSF detects blood, WBCs, meningitis
The 2 essential things the brain needs to survive are O2 & glucose
Brain 80% of skull's contents
CSF 10% of skull's contents
Blood 10% of skull's contents
Hypercapnia Increased cerebral vasodilation then increased blood flow then increased ICP
Hypoxemia Cerebral vasodilation, which raises ICP
Vasodilator drugs increase cerebral blood flow -> temp increased ICP (Nitroglycerin)
Cerebral Perfusion Pressure Pressure needed to perfuse brain cells
Normal CPP 70-100 mm Hg
CPP < 50 irreversible brain dmg
Created by: lost little girl