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med surg

neuro- integumentary

QuestionAnswer
what is meningitis inflammation of all the meninges, however the organisms predominantly invloved are the arachnoid and subarachnoid spaces
what are the s/s nuchal rigidity(rigidity of the neck), brudzinskis sign, and kernigs sign, and photophobia
how is meningitis dx positive kernigs sign and brudzinskis sign, gram stain of the CSF reveals organisms,
viral vs. bacterial bacterial is contagous, viral manifestations different b/n different organisms.
what lab findings do you expect to see moderately elevated CSF pressure, elevated CSF protein, decreased glucose, elevated white blood cells count.
what assessment data is critical? assessment of clinical manifestations,
what meds to treat? cephalosporins
what is tetanus caused by the anaerobic spores forming rod clostridium tetani, tetanus may be found in some people wit some form of trauma and no history of tetanus immunization, bacteria enters the bloodstream from the wound and travels to the cns and pns
note: wounds closer to the head the neurotoxins cause tetanus more quickly.
prevented? immunization every 10 years,
assessment data painful muscular spasms, and contractionin the affected extremity. muscular contraction of neck and facial muscles, cheecks and jaws -trismus
risus sardonicus grotesque grinning expression
prognosis 25%to 50% depending on where
what is gullian barre syndrome is an inflammatory disease of unknown origin that involves degeneration of the mylein sheath of peripheral nerves
course of the disease ascending weakness, usually beginning in the lower exteremities and spreading, some times rapidly, to the trunk, upper extremities, and even the face. the weakness evolves over hours to days with maximal deficit by 4 weeks in 90% cases
manifestiations deep tendon reflexs are lost, paresthesia (tingling)
plateau phase no longer progresses, does not recover from functions initially lost, deep aching muscle pain in the shoulder girdle and thighs is common,
2 most dangerous features of the disease respiratory muscle weakness, and autonomic neuropathy involving both the sympathetic and parasympathetic systems.
latter features include orthostatic hypotension, hypertension, pupillary distrubance, sweating dysfunction, cardiac ysthrimias, parlytic ileus, urinary retention
recovery phase improvement and recovery occur with remylenation. occurs in a descending pattern, those lost last are restored first. recovery is 6 months,to upto 2 years.
diagnosis history and physical exam, csf exam, electrophsiologic studies, csf contains increased proteins, with few or no white blood cells, nerve conduction velocity is slowed, conduction block.
prognosis 85% to 90% of clients recover completely
what is trigeminal neuralgia chronic irritation of the fifth cranial nerve, douloureux, 50 to 70 year olds and 60% of clients are women affecting either the ophthalmic, maxillary, or mandibular division
caused trinsic or extrinsic lesions within the nerve itself, gross abnormalities of the axon or mylein, with multiple sclerosis,
extrinsic factors lesions outside trigeminal root and include mechanical compression by tumors, vascular anomalies , dental abscesses or jaw malformation.
characterized by intermittent episodes of intense pain of sudden onset rarely releived by analgesics. tacticle stimulation may trigger ex. touch facial hygiene, talking
more prevalent maxillary and mandibular distributions, and on the right side of the face. can be so intese the patient considers suicide.
diagnostic studies find lesions angiography, CT, and MRI, causative lesions, dx made from basis of an indepth history with attention paid to trigger stimuli and nature of the pain site
meds anticonvulsants such as tegretol, dampen the reactivity of the neurons, liver impairment may result from carbamazepine, and phenytoin liver enzymes must be monitored during and before therapy
meds cont. Lioseral is an antispasmotic used alone or with anticonvulsants, opoids are not effective
nx considerations clients do not usually meet intake requirements. also need emotional support,
surgery includes nerve blocks with alcohol,or glycerol, peripheral neruectomy, percutaneous radiofrequency wave forms that create lesions that alter pain transmissions.rhizotomy, resection of the root of the nerve
complications development of facial parathesias and muscular weakness,
assess aspiration, advance diet slowly, teach patient to use water jet device corneal reflex may be inpaired
what is bells palsy affects the motor aspect of the facial nerve, the 7th cranial nerve. common type of peripheral facial paralysis, commomly among 20 to 40 yr.
cause unilateral paralysis of the facial muscles of expression, no pathological cause, paralysis may be central or peripheral in origin,
central facial palsy upper motor neuron paralysis of paraesis, sometimes causes dissociation of motor function, pt. cannot voluntarily show teeth on the paralyzed side, can show emotional stimulation-sudden laugh.(voluntary emotional dissociation)
manifestaitons upward movement of the eyeballon closing the eye(bells phenonmenon)
contd drooping of the mouth, flattening of the nasolabial fold, widening of the palpebral fissure, a slight lag in closing the eye , eating may be difficult
no known cure care is palative, analgesics for comfort, corticosteroids for edema, physical therapy with moist heat, gentle massage, stimulation of nerve with faradic current, cornea protected with artifical tears, eye patch at night
recovery within a few weeks without manifestations, if perminant paralysis then surgery may be needed
actinic ultraviolet light
amelanotic without pigment
circinate circular
circumscribed limited to a certain area by sharply defined border
coalesce to merge one with another
comedo plug in skin duct containing keratin (whitehead or blackhead)
cytotoxic toxic to cells
dermatome area of skin supplied by a single dorsal nerve root
dermatophyte fungus that enters the skins surfacec causing infection
desquamation scaling, peeling of epidermis
discoid coin like
eczematous general term for disease process characterized by dxaling, weeping, crusting and inflammation
erythema redness
exacerbation worsening of disease state
exfoliative shedding of skin in fairly large quanities
folliculitis hair follicle inflammtation
guttate small, water drop size lesions, usually widespread
hives spontaneously occuring wheals
hyperkeratosis thickening of strateum corneaum, usually from repeated pressure or friction
hyperpigmentation increased or excessive skin pigmentation(melanin) causing a darkening of the skin than the surrounding area
hypopigmentaiton decreased pigmentation
indurated hard
intertrigo irritation of body areas with opposing skinflods that are subject to friction
lesion detectable change from normal skin structure
maceration tissue softening or disinteration from excessive moisture
milia small white papula
perioral around the mouth
periungual under the nail bed
pigmentation degree of skin color, or mucous membrane color
plantar pertaining to the sole of the foot
polymorphic existing in many forms
pruritis itching
punctate pinpoint
sclerosis hardening or induration of skin
sebum lipid excretion produced by sebacous glands
tautness degree of skin tightness
texture tactile or visual skin characteristics, coarsenenss or dryness
ultraviolet light electromagnetic radiaiton from the sun
urticaria wheals hives
verruca leasion with surface roughness , wart
macule skin color change without elevation, flat, described as a patch, if greater than 1 cm. (freckles or petechia)
papule elevated solid lesion of less than 1 cm varying in color (warts or elevated nevus)
plaque raised, flat lesion formed from merging papules or nodules
nodule larger than a papule, raised solid lesion extending deeper into the dermis, a large noduleis referred to as a tumor
wheal hive, fleeting skin elevation that is irregularly shaped because of edema, mosquito bite
vesicle blister, elevated, sharply defined lesion containing serous fluid, usually less than 1cm blister, chickenpox, or herpes simplex
bulla large elevated, fluidfilled lesion greater than 1cm partial thickness burn
CYST elevated, thick walled lesion containing fluid or semisolid matter.
pustule elevated lesion less than 1cm contaioning purulent material, lesions larger that 1cm are described as boils, abscesses or furncles, acne or impetigo
physical exam examine skin thoroughly, use inspection, palpatation, olfaction to asess hair, nails, and skin,
inspection and palpation hair and scalp, nails- color and shape, texture, integrity, thickness/ skin-color, moisture, temp, tex, turgor, edema, tender, odor,
lesion exam location, distribution, size, arrangement, color, configuratuion
skin self test a-asymmerty/ b-border/c-color/d-diameter/
scale dried fragments of sloughed epidermal cells, irregular in shape and size and white,tan, yellow or silver in color, (dandruff, dry skin or psoriasis)
crust dried serum, sebum, blood, or pus on skinsurface producing a temporary barrier to the envirionment (impetigo)
erosion a moist, demarcated depressed area due to loss of partial or full thickness epidermis, basal layer of epidermis reamains intact (ruputured chickenpox vesicle)
ulcer irregular shaped, exudative, depressed lesion in which entire epidermis and all or part of dermis are lost, results from trauma and tissue destruction (pressure ulcer)
scar mark left on skin after healing replacement of destroyed tissue by scare tissue
lichenification epidermal thichening resulting in elevation plaque with accentuated skin markings, usually results from repeated injury through rubbing odr scratiching chronic atopic dermatitis
excoration superficial, linear abradion of wpidermis, visisble sign of itching caused by rubbing or scratiching atopic dermatisis
fissure deep linear split through epidermis into dermis tinea pedis
atrophy wasting of epidermis in whichh skin appears thin and transparant or of dermis in which there is a depressed area arterial insufficiency
atopic dermatitis a chronic relapsing , pruritic eczema, atiopic refers to familial tendency. for excess inflammation in the skin, linning of teh nose and lungs,
familial hay fever, asthma, sensitive skin and a hx of eruptions called atiopic dermatitis
patho immunoregulatory abnormalities have , caused by dysfunction of skin t cells,
Tcell activation release of cytokines and inflammatory mediatiors, has reduced watere binding capacity, higher rate of transepidermal water loss, decreased water content, water loss leads to further drying and cracking and itching,
manifestations begins during infantacy, acute onset, red, oozing crusting rash, shows chronic form of dermatitis, thickened dry texture, brownish grey and scales, rash localized to large folds of the extremeties as pt gets older.
contd found mainly on elbow bends, backs of knees, the neck, eyelids, the backs of hands and feet. pruritis causes great morbidity, provoking scratching which results in severly excoriated lesions, infection, and scarring
contact dermatitis inflammatory response irritant or allergic, allergic is a delayed hypersensitivity reaction,
management causative factors, topical meds, wet dressings, antihistamine, topical or systemic steroids,
reconstructive surgery skin flaps- are sections of skin rotated from their origin to cover a defect. connonuses of skin flaps to reconsrtuct a neck after excision of cancer, occasionally used to close pressur ulcers on the pelvis, blood flow must be protected,
musculocutaneous flaps comprised of both muscle and skin, used to fill in defects where muscle is missing or where muscle can provide ample blood flow to heal osteomyletiis, named by the muscle of origin,
outcome pt will maintain effective peripheral tissue perfusion as evidenced by usual color of skin, no pallor or cyanosism, warm and dry skin, blanching no edema or blebs
free flaps thrombosis is the most common failure of free flaps,
names of flaps axial skin flap, muscle flap plus skin graft, muocutaneous flap, omental flap
Created by: chevapourfarhadi