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NUR 141 EXAM 3

QuestionAnswer
for intestinal disorders you need to interrupt one of the following... digestion, secretion, absorption, motility (segmentation (mixing), peristalsis (propulsion)), elimination
intestinal disorders occur d/t inflam, inf, tumors, obstr, structural problems
manifestations of dysfunction pain, hemorrhage, N/V, distention, constipation, diarrhea, abnormal fecal contents, incontinence
lactose intolerance enzyme deficiency, missing lactace, afros and asians, undigested CHO
celia disease automimmune damage to villi when gluten is consumed: wheat, oats, barley, rye
IBD crohns and colitis
cystic fibrosis genetic, mucus accumulation=pancreatic dysfunction, protein and fat digestion problems
steatorrhea fatty stools
oxalates cause kidney stones
inflam of hte gastrointestinal tract gastroenteritis
gastroenteritis is caused by inf organisms (virus, bacteria, parasites)
source of inf of gastro contaminated food/water, contact w inf person, dirty utensils, fecal-oral,
patho of gastro inflam alters secretion and absorption due to direct damage or production of toxins
s/s and dx of gastroenteritis N/V, abd pain/flatulence, systemic fever, body aches, diarrhea, dehydration, electrolyte loss, stool
labs for dehydration inc Hgb, inc Hct, inc BUN, inc Creat
labs for stool ova/parasite, culture, WBCs, or toxins. test takes days d/t normal flora in stool
major health care associated inf C. diff (clostridium difficele)
C. Diff occurs in.. immunocompromised pt after antibiotic tx that destroys normal flora, spores last 70 days on surfaces
Tx for C. Diff constact isolation, metronidazole (fLAGYL), vancomycin, stool transplant (not in immunocompromised)
diet for gastroenteritis NPO until V stops, tx N/V, I/O, isolation, antibiotics, antimicrobials, no anti-diarrheals
IBS chronic functional GI disorder, more in women
s/s IBS abd pain, alternating diarrhea or constipation, flatulence, foul breath, N, anorexia, anxiety/depression, mucus stools
risks for IBS stress, ETOH, smoking, lactose intol, specific food intol, psych factors
tx for IBS high fiber (20gm), probiotics, low fat, no carb beverages or ETOH
meds for IBS SSEI, loperamide (Imodium) for diarrhea, lubipostone (Amitzia) for constipation, alosetron (Lotronex) restricted access program
Inflammatory bowel disease ulcerative colitis/chrones; chronic inflam of the GI tract, relapses/remissions, overractionto normal bacteria, 20yo and 60yo, genetic, more in whites
s/s of inflam bowel disease diarrhea, bloody stools, wt loss, abd pain, fever, fatigue, skidney stones, liver disease, thromboembolism
complications of inflam bowel desease hemorrhage, stricture/obstruction, perforation, fistula, colonic dilatation, nurtritional probs, sclerosing cholangisits, gallstones, liver failure
DX of inflam bowel diesease labs, stool-+for blood, pus, mucus, signmoidoscopy, colonoscopy, EGD, barium enema, CT w contrast
IBD collaborative care goals rest bowel, induce remission, , inflam control, correct malnutrition, reduce stress, stop smoking
meds for IBD 5-aminosalicylate (saulfasalazine (Azulfidine)), antimicrobials, corticosteriods, immunosuppressants, biologic and targeted therapies, antidiarrheals (Imodium), hematologics and vit (iron, potassium, zinc)
nutritional therapy for IBD fluid/electrolyte, high calorie, low fiber, residue, fat, small meals, no trigger foods, TPN
surgical intervention for chrones common, high recurrence rate, short bowel syndrome, emergency situations
surgical intervention for ulcerative colitis less common, total proctocolectomy is curative
dec freq, difficulty passing stools, dec volume, retained feces in the rectum constipation
causes of contstipation insufficient dietary fiber and fluids, dec physical activity, ignoring defecation urge, laxative abuse
causes of constipation related to age dec secretion of digestive enzymes, dec muscle tone abd wall
s/s constipation distention, bloating, flatulence, inc rectal pressure, hemorrhoid
related to venous engorgement with straining hemorrhoids
related to Valsalva cardiac problems
severe constipation, no stools/gas expelled obstipation
accumulation of hardened stool that cant be expelled fecal impaction-leaking of stool
tx for atonic constipation high fiber, use natural foods, increase water intake , activity
diverticulosis asymptomatice, seen w scope, high fiber diet, wt loss, no straining, tight clothes and lifting. no nuts/seeds
diverticulitis pain, inc WBC, fever, CT scan, colon rest, NPO, IV fluids, progression of food first mush.
lesions of mucosal surface that progect into lumen of the bowel colon polyp
non cancerous, limited growth hyperplastic
linked to colorectal adenocarcenoma "mushroom" adenomatous
third most common form of cancer in US, familia colorectal cancer, second leading cause of death
risk factors for colorectal cancer s/s dont appear until desease is advanced, obesity, smoling ETOH, large intake of processed meats
decrease risk for colorectal cancer exercise, diet large mts of fruits, veggies and grains
s/s of colorectal cancer pain, change in bowel habits, anemia, distention/obstruction, wt loss, N/V, black stools, blood in stool, hemorrhage
tx for colorectal cancer resect tumor, restore bowel, ostomy, chemo, targeted biologics, radiation
targeted biologics for colorectal cancer bevicizumb (Avastin)-prevents agiogenesis in the tumor, cetuximab (Erbitux) blocks epidermal growth factor receptor
skin assessment hx onset/duration of problem, relationship (season, travel, etc), symptoms, hx oa associated illness
factors for assessment good lighting, room comfortable temp, cosmetics removed, inspect mailbeds, oral mucous membranes on dark skinned pts.
decreased blood supply as in COPD, vascular disorders cyanosis
vasicilation oas in fever cellutitis flushing
skin lesion that drains from 1 hole, painful furuncle
skin lesion that drains from any locations, usually staph, fever carbuncle
purilant skin infection pyoderma (pyo=puss)
furuncles/carbuncles need... antibiotics and incision to drain
secondary skin inf changes in skin due to scratching, irritation, inf, meds, invironment
blistering that is a response to a med steven johnson
inflammation of subcutaneous tissue cellulitis
s/s of cellulitis hot, tender, red, edema, diffused borders
tx of cellulitis moist heat, immobilization, elevation, antibiotic. can goto gangrene. no amb until under control
viral skin disease very contagious, transmit easy, wore w immunosuppressed, avoid antibiotics (masks symptoms)
shingles follows nerve pathways, pain before lesions, painful, fever, itch.
meds for shingles Zovirax, Famvir, analgesics, steroids to relieve pain and itch
benign grown due to a virus wart-verucca. bleeding can spread virus
skin fold appear moist and beefy red or brown, itch may have pustules on edge fungal skin infections
tx for fungal skin inf keep skin cool dry, leather, topicals
tenea capitis craddle cap
candida oral thrush
vitiligo loss of skin pigment
chronic dermatitis, papular lesions with scalling borders, redness, mostly on scalp, elbow, knees psoriasis
tx for psoriasis UV light, tegison, methotrexate, corticosteroids
Tegison causes birth defects, visual disturbances, hepititis
Methotrexate causes liver toxicity, take no asprin
corticosteroids apply after scales are removed, wet skin, cover w plastic
development of new pigment, sudden mole, loss/gain of hair, bleeding seborrheic keratoses-mostly benign
tumor arising from melanocytes, metastasizes to any organ melignant melanoma
gross distortion of reality, disturbances of language, communication, withdrawal, thought fragmentation schizophrenia
s/s of schizophrenia apathy, confusion, delusions, hallucinations, speech probs, bizarre behavior
persistent averant (incorrect) belief or perception that the pt cant b convinced otherwise despite of evidence to the contrary delusional
sensory perception that doesnt result from an external stimulus in an awake state. auditory, gustatory, tactile, olfactory, visual hallucinations
schizoid personality (schizophrenia phase 1) loners, limited range of emotional expression, withdrawn
prodromal phase (2) eccentric behavior, withdrawn, impaired role function, disturbances in communication, neglect of personal hygiene
schizophrenia (3) delusions, hallucinations, disorganized speech, catatonic behavior
residual phase (4) periods of remissions and exacerbations, depends on if they are taking meds or not
tx for schizophrenia individual/group/behavioral therapy,
meds for schizophrenia major tranquilizers, antipsychotic drugs. blocks dopamine in the brain
phenothiazines thorazine, mellaril
thiozanthenes navane
nonphenothiazines haldol, zyprexa, resperdal
alteration in mood depression
s/s depression sadness, crying, withdrawn, cant concentrate, insomnia, anorexia, constipation, HA, fatigue
NS interventions ask if they r thinking of killing self, make contract, meds, trust, make chage, set goals
anti depressio nmeds effect neurotransmitter levels. MAOs, tricyclic antidepressants, slective serotonin, uptake inhibitors (SSRI),
MAOs dont use much anymore, diet restrictions, many side effects
tricyclic antidepressants Rememron, Desyrel
SSRIs best ones. Clexa, Lexapro, Prozac, Paxil, Zoloft
Others Wllbutrin, Cymbalta, Effexor
mood swings from profound depression to extreme euphoria (mania) bipolar disorder
stage 1 hypomania-good mood, helpful
stage 2 everything is wonderful, euphoric, do inappropriate things, dec hygiene and sleep.
stage 3 exaggerated mood swings, stooperous, confused, most unsafe
Ns interventons for bipolar reduce stimuli, safety, calmness, set limits, meds
meds for bipolar major tranquilizers, phenothiazines and lithium for the acute manic phases. can easily od on lithium
diffuse apprehension that is vague in nature and is associated with feeling of uncertainty and helplessness anxiety disorder
affects ability to respond, more restless moderate anxiety
unable to concentrate, cant complete task, HA, heart palpitations, insomnia, dread, horror severe anxiety
unable to focus, hallucinations, delusions, withdrawn, confusion, feeling of terror, poor decisions panic anxiety
anxiety disorder meds action act at the limbic, thalamic and hypothalamic levels to produce calming
benzodiazepines Xanax, Valium, Ativan
non-benzodiazepines BuSpar, Atarax, Vistaril
others tranquilizers
NS interventions for Anxiety disorders any additional probs, what stressors, family support, accept, educate, coordinate care
assessment of suicide elicit info, have a plan, hx of previous attempts, refuse to sign contract, live alone, ETOH, drugs, psychosis
Kubler-Ross stages of grieving denial/isolation, anger, bargaining, depression, acceptance
worden and harper basic tasks of grief accept the reality of the loss, experience the pain of grief, adjust to an environment in which the individual is missing, refocus emotional energy
risk factors for complicated grief sudden death, marked dependence, lack of support system, loss of a child, perception of preventable death
NS interventions for grieving support, assess how pt reacts to loss, understand the normal grief process, assess s/s of maladaptive response
maladaptive response to grieving preserving, intense/distorted occurrences, mental/physical disorders, suicide
s/s of approaching death extremities cool/discolored (molded), inc sleeping, hard to arouse, lose bowel/bladder control, poor swallow, restless, resp patterns change, can hear
if an autopsy is to be done... leave all lines in.
criteria for hospice terminal illness, death within one year, DNR status
how to deal w death at work get help, know your limitations, leave work at work
ascending symmetric paralysis that usually affects cranial and pereipheral nervous system Guillain-Barre Syndrome
Guillain-Barre Syndrome loss of mylein, edema, inflam of affected nerves that stops or slows nerve impulses
Guillain-Barre Syndrome occurs after a... upper respiratory or GI inf-resp failure most serious
Dx for GBS CSF-elevated protein, EMG-nerve and muscle function in affected extremities
NS management of GBS monitor ascending paralysis, resp functin, arterial blood gases, gag and swallowing reflexes, BP, HR and rythm
amyotrophic lateral sclerosis Lou Gehrigs desease-rare, loss of motor neurons resulting in degeneration of motor neurons in the brainstem and spinal cord.
s/s of ALS weakness upper extremities, dysarthria(difficulty articulating words), dysphagia, muscle twitching, pain, spasicity, drooling,const, esophageal reflux
Dx of ALS nothing rule out others
px of ALS death in 2-6yrs from resp inf
disease disseminated demyelination of the nerve fibers of the brain and spinal cord. MS-multiple sclerosis-disease of the young to middle aged adults.
Risk factors for MS women (2-3x more than men), 5x more in US, Canada and Europe than tropical, family relative w MS
MS is marked by exacerbations/remissions. attack of mylin sheath then regrow of. slerotic plaque on nerves
dx of MS hx, physical exam, clinical mans, lesions in brain from MRI
teaching for MS management avoid triggers, balanced exercise, rest and nutrition, no hot/cold climate, exposure to inf, fatigue, follow drug regimen .
Chronic, progressive neurodegnerative disease Parkinson’s Disease-Slowness in initiation/execution of movement, bradykinesia)Increased muscle tone.(rigidity)Tremor at rest. Gait disturbance.
Clinical Manifestations of parkinsons gradual/insidious, r/l sided, 70 yo, more males
Beginning stages of parkinsons Mild tremor (first sign) Slight limp,Decreased arm swing.
Later Stages of parkinsons Shuffling Gait Propulsive gait with arms flexed,Loss of postural reflexes,Slight change in speech
Tremors of parkinsons First sign,Pt. may only notice, Effect in handwritting,Aggravated by emotional stress,Tremors can involve:Diaphram,Tongue,Lips,Jaw
Rigidity of parkinsons Second sign,Sustained muscle contractions,Muscle soreness,Feeling tired Achy Pain head, upper body, spine, and legs Slowness of movement
Bradykinesia of parkinsons Loss of automatic movements(involuntary),Stooped posture,Masked face,Drooling,Shuffling gait
Diagnostic Studies of parkinsons Not set test.Must have 2 of 3 symptoms present:Tremor,Rigidity, Bradykinesia; Ultimate confirmation is positive response to antiparkinsonian drugs
med for Parkinsons-levodopa/carbidopa (Sinemet) Blocks the effects of the overactive cholinergic neurons. Treats bradydinesia, tremors, and rigidity
Anticholinergics Artane, Cogentin, Akineton. Treats tremors
Antihistamine Benadryl Treats tremors and rigidity
MOI Eldepryl, Crebex, Azilect Treats bradydinesia, tremors, and rigidity
disease that destroys the brain alzheimers-60 yo, genetic, b-amyloid plaques, neurofibrillary tangles,
s/s alzheimers subtle memory loss, final stage unresponsive, incontinent
TIA A transient ischemic attack episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but w/o acute infarction of the brain.
A stroke, caused by an event that causes more permanent damage to a larger area of the brain resulting in more widespread damage and more permanent disability CVA Cerebral Vascular Accident-caused by plaque
A stroke that a patient is able to fully recover from within a few weeks. RIND Reversible Ischemic Neurological Deficit
Etiology of a stroke A stroke occurs when there is ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the brain that results in death of the brain cells
Risk factors for stroke doubles each decade over 55yrs, more common in men, but more women die from it, African/ American, family history/heredity
modifiable Risk factors for stroke Hypertension, Heart disease, Diabetes Mellitus, High cholesterol Smoking,Alcohol,Obesity,
Results from bleeding into the brain tissue itself or into the subarachnoid splace or ventricles. Hemorrhagic stroke
Results from inadequate blood flow to the brain from partial or complete occlusion of an artery. Ischemic Stroke
right hemisphere stroke left-sided weakness, rash in judgement, inc falls, "left neglect", impulsivity, cant recognize body parts, probs w depth perception, cant see left in each eye(homonymous hemianopsia)
left hemisphere stroke right-sided weakness, receptive/global aphasia, dec decision making, cant see right in each eye(homonymous hemianopsia), behavioral changes, apraxia
aphasia traditionally associated with neurological damage to Wernicke’s area in the brain. language area Receptive aphasia
inability to properly move the muscles of the tongue and mouth to produce speech. Expressive aphasia
impairment of both comprehension and expression of language. often mute or reduced to a few stereotyped words or sounds Global aphasia
Inability to perform learned movements despite having desire and physical ability to perform them. Apraxia
a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system Dysarthria
a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function. Seizure
a condition in which a person has spontaneously recurring seizures caused by a chronic underlying condition Epilepsy
involve both sides of the brain, Loose consciousness for a few seconds to several minutes. GENERALIZED
occurs in children, staring spell absence seizures
loss of consciousness and falling to the ground tonic clonic
Dx of seizure EEG
peculiar sensation that precedes a seizure aura
interventions for seizure ensure airway, protect from injury, time seizure, say w pt until gone, pt on side, remove tight clothing
drugs for seizure anti-convulsived- Ativan, Valium, Tegritol, Felbatol
drugs given IV for staticus epilepticus (rapid acting) Ativan and Valium
Don’t take with grapefruit, report visual abnormalities, abrupt withdrawal after long term use may precipitate seizures. Tegritol
Use is limited. It can cause aplastic anemia and liver toxicity. Mostly used to treat patients who are resistant to other drugs. Felbatol
(long acting) anti-convulsive durgs phenytoin, phenobarbital, ethosuximide, lamotrigine, topiramate
Dilantin good oral hygene, tack 2-3 hours of antacids, use additional contraceptive
LEADING CAUSE OF BLINDNESS WORLDWIDE! CATARACTS:An opacity within then lens
NON-SURGICAL tx for cateracts changing prescriptions, using magnifiers, increasing the amount of light, adjusting his/her lifestyle, reassurance
surgical tx for cateracts NPO 6-8hrs, antibiotic drops, dilation of eye, removal of lens nucleus and coretex, corticosteroid drops
post surgical instuctions no stooping, lifting, coughing, call dr for any drainage, analgesic for pain
FOUR DISEASES MOST COMMONLY CAUSING BLINDNESS IN OLDER PERSON: Cataracts, Viral infections, Chlamydial infections, Glaucoma
Clinical Manifestions of cateracts decrease in vision (gradual), abnormal color perception, and glare.
related to consequences of increased intraocular pressure (IOP), optic nerve atrophy and peripheral visual field loss GLAUCOMA-Second leading cause of permanent blindness and leading cause of blindness in African Americans.
the outflow of aqueous humor is decreased in the trabecular mesh work. Most common type. Primary open-angle glaucoma (POAG)
due to reduction in the outflow of aqueous humor that results from angle closure. Primary angle-closure glaucoma (PACG)
clinical mans of Primary angle-closure glaucoma (PACG) N&V, sudden, excruciating pain in/around eye, halos around lights, blurred vision, ocular redness
clinical mans of Primary open-angle glaucoma (POAG) Tunnel vision (PAOG)
Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers RETINAL DETACHMENT
CLINICAL MANIFESTATIONS OF RETINAL DETACHMENT Photopsia (light flashes), floaters, “cobwebs”,“hairnets”, Ring in the field of vision
The area of visual field loss is the center of the visual field (the macula) because of damage to the retina. MACULAR DEGENERATION
Conductive Hearing Loss cerumen (earwax build up, ear infection or sometimes tumors) to external/middle ear.
Damage to the inner ear functions can cause hearing and equillibrium problems Sensori-Neural Hearing Loss-Can be abnormal at birth or caused by damage.
Hearing loss due to aging. Sound transmission is diminished Loss of high pitched sound hearing Tinnitus Increased wax/hair production blocks sound transmission Loss of elasticity of cartilage Reduced blood supply to ear Decline in ability to filter out unwanted sound
Care of hearing aid When not worn Remove or disconnect battery, Clean Ear molds weekly, ear tip w toothpick
determines hearing range of patient in terms of decibels (sound intensity), and Hertz (pitch) for diagnosis of conductive and sensorineural hearing loss. Audiometry
can cause inconsistent results to audiometry tinnitus
assessing vertigo ask... hearing changes, dizziness or spinning, ringing in the ears, food allergies, staining during BM, changes in sleep, communication and during exercise
The cause is unknown but it results in an excessive accumulation of endolymph causing pressure in the membranous labyrinth (inner ear) Meniere’s Disease
s/s of meniere's disease severe attacks with nausea, vomiting, sweating and pallor, Tinnitus, fluctuating sensori-neural hearing loss, aural fullness.
meds for meniere's disease(during attacks) Benadryl, atropine and ativan can be used to decrease the abnormal sensation and lessen N/V Antiemetics- Compazine Antivertigo- Antivert administered IV, orally or rectally
meds for meniere's disease(between attacks) Antihistamines, calcium channel blockers and a low sodium diet Valium, fentanyl with innovar may be used to reduce the vertigo
Surgical interventions for meniere's Decompression of endolyphatic sac and shunting, vestibular nerve resection, Labyrinthectomy
Patient care got meniere'sde safe room, dark room (NO TV, lights on low),Assist patient to comfortable position,Have emesis basin at bedside,Keep bedrails up and bed in locked/low position, Instruct patient to use call light for assistance when getting up,Monitor I/O
Hydrops diet for meniere's Restriction of sodium, caffeine, nicotine, alcohol and foods with MSG fluid buildups in the inner ear, lessen attacks
irritation of sensory branch of 5th cranial nerve TRIGEMINAL NEURALGIA-in women >40, triggered by touch or temp
s/s of trigeminal neuralgia intermittent, sudden-onset severe facial pain; unilateral; + blinking, tearing, jerking; unpredictable; clusters possible
tx for TN antiseizure meds-decrease in neuron firing to block movement.
Cause: unknown, affects the motor aspects of the 7th CN (facial nerve), ? Inflammation RT Herpes virus BELL’S PALSY
s/s of bells palsy unilateral, drooping of mouth, eye rolls up when closing eyelid; can have difficulty with eating; tearing, lasts <6mtns
tx for bells palsy MEDS: steroids, analgesics, eye protection PT/OT
abnormal, excessive, involuntary movements HUNTINGTON’S DISEASE -chorea
autosomal dominant genetic disorder (men = women) that results in changes in neurotransmitters and degeneration of basal ganglia (onset most common 30-50 years) HUNTINGTON’S DISEASE -chorea
s/s of huntingtons disease progressive, death within 15-20 yrs Abnormal muscle movement: voluntary & involuntary impacted Emotional disturbances & personality change Intellectual decline
prion disorder (infectious protein) CNS disease; effects dependent on where proteins are active. Can be genetic or infectious. 4 – 21 yr incubation. CREUTZFELDT-JAKOB DISEASE
s/s of CREUTZFELDT-JAKOB DISEASE RAPID PROGRESSION (wks to months) Behavior and personality change CNS: memory, vision loss, dysphagia, abnormal movement
dx of CREUTZFELDT-JAKOB DISEASE autopsy
bilateral, “pressing-tightening”, most common, mild-moderate; no triggering event. Duration 30 min – 7 days tension HA
- rare, repeated HA over weeks or months; “sharp/stabbing”; periods of remission; swelling around eyes; congestion or tearing cluster
recurring, often unilateral, “throbbing”; family tendency Improves with sleep. Can have N & V, photophobia and be preceded by prodrome. migraine
meds and tx of HA reduce inflammation of cerebral blood vessels & vasoconstrict, : diary to determine triggers, treat symptoms ASAP, rest, reduce stress, R/O other brain pathology
brain tumor arises from tissues within brain primary
brain tumor metastatic, most common secondary
s/s of brain tumor HA, N & V (inc. ICP), Behavior change,Muscle weakness, Seizures, cognitive problems(Memory,Personality & mood) Sensory losses,Hydrocephalus
tx of brain tumors Surgery, Radiation, Chemo, Symptom management: shunts
alterations in thought, acute, shorterm confusion
temporary acuteconfusion,inattention Disorganized thinking Altered LOC delirium
Chronic confusion Multiple memory problems Gradual decline dementia
Records electrical activity of the brain using scalp electrodes. Noninvasive. EEG- Electroencephalography-Clean hair, Check meds, NO CAFFEINE 8 hrs before test,
Records electrical activity associated with innervation of skeletal muscle. Needle electrodes into muscle. Normal skeletal muscle has no electrical activity at rest EMG - Electromyography- looks at speed of depolarization
Computer-assisted xray of multiple cross sections. Noninvasive. CT-Computed tomography-Some studies will utilize IV contrast media.
Uses magnetic field & radio waves to create detailed image MRI – Magnetic resonance imaging, Greater contrast & better images of soft tissue. Can do 3D.Noninvasive but claustrophobic, noisy, and metal risks, Can use contrast media to enhance images, Pt must BE VERY STILL.
Measures the metabolic activity of tissue at the cellular level. (CT & MRI evaluate structural changes). PET – Positron emission tomography-Requires IV injection of radioactive tracer.Provides 3D images. Can measure blood flow, O2 use, & glucose metabolism in tissues. Earlier detection of problems, Pt must BE VERY STILL.
Evaluates vascular status by inserting catheter (groin) & threading catheter to carotid and contrast inserted. Angiogram (cerebral arteriogram-Serial images to evaluate flow of the dye, INVASIVE and risk of allergy due to contrast media.Aftercare of puncture site to prevent/detect bleeding
EMERGENCY TX OF ISCHEMIC STROKE Recombinant tissue plasminogen activator(tPA): fibrinolysis – reestablishes circulation
ESSENTIAL MEDS FOR CVA ANTI-PLATELET, ANTICOAGULANTS, Antihypertensives, Statins,Diabetic meds
interaction with the environment that promotes homeostasis ADAPTATION:
loss of equilibrium, physical and mental illness, loss of identity and self-esteem MALADAPTATION
Compensation making up for a deficiency by emphasizing a feature considered an asset.
Conversion unconsciously repressing an anxiety producing emotion conflict and causing difficulty sleeping, loss of appetite etc....
Denial avoiding emotional conflicts
Displacement transferring anger over an interpersonal conflict to a malfunction VCR
Identification acting like someone else
Dissociation subjective sense of numbing and reduced awareness of ones surroundings
Regression coping with stressor by going back to childhood
PSYCHOPHYSIOLOGICAL and should be tx like a real illness. Drs feel like these are in your head HA, backache, arthritis, asthma, wheezing, diarrhea, anorexia, HB, Colds, infection, RA, GU, agina, hypertension, hypoglycemia, lupus
s/s of ETOH withdrawl TREMORS, ANOREXIA, ANXIETY, RESTLESSNESS, INSOMNIA, ABDOMINAL PAIN, NAUSEA, DIAPHORESIS,
s/s of delirium tremmens from ETOH DISORIENTATION, NIGHTMARES, VISUAL/AUDITORY HALLUCINATIONS, HYPERTENSION, DELUSIONS, CARDIAC PROBLEMS
TREATMENT FOR WITH- DRAWAL SYMPTOMS SUPPORT, REASSURANCE, MONITOR, PROTECT FROM INJURY, one to one supervision
tx with meds for withdrawl VALIUM -SERAX LIBRIUM -ANTIVAN
CHRONIC ALCOHOLISM can Cause Degeneration brain tissue Deficiency of Thiamine Wernicke’s Encephalopathy-s/s=Ataxia, confusion, nystagmus. tx=IV Thiamine, Glucose replacement
Untreated Wernicke’s encephalopathy Korsakoff’s Psychosis=s/s shorterm memory loss. tx=IV Thiamine, Glucose replacement
NICOTINE EFFECTS TACHYCARDIA, VASOCONSTRICTS, dry ORAL MM, COUGH, LUNG DAMAGE, EMPHYSEMA, CANCER
Nicotine Replacement: Nicotine gum, lozenges, patches, nasal spray, inhaler
Non-nicotine agents: Zyban, Chantix, Aventyl, Catapres
abnormal malignant proliferation of plasma cells MULTIPLE MYELOMA, middle to old, age 60 years, more common males and blacks
s/s of multiple myeloma bone pain, anorexia, numbness, weakness, CHF, visual problems, headache, confusion,
DIAGNOSIS of MULTIPLE MYELOMA x-ray, hematology=Bence-Jones protein--affects renal tubules increased calcium levels
TREATMENT MULTIPLE MYELOMA chemotherapy, malphalan, prednisone anticalcium agents, localized radiation
Nursing Interventions MULTIPLE MYELOMA high risk for injury, increase fluids, pain relief, prevent infection, rest and avoid fatigue, spinal brace
stage 1 lymphoma single lymph node involvement
Stage two two—two or more—one side of diaphragm
Stage three lymph node involvement above and below the diaphragm
Stage four involvement outside the diaphragm
Acute non-lymphcytic leukemia resp. infections, anemia, bleeding mm, lymphoblasts inc.,hepatomegaly, splenomegaly, bone pain, CNS symptoms
Chronic myelogenous leukemia fatigue, weakness, anorexia, wt. Loss, blastic phase, anemia, thrombocytopenia, fever,
etiology of leukemia cause unknown, genetic predisposition, viral origins, radiation and chemical exposure, medication/drug related
Methods of transmission of HIV intimate contact with body secretions, blood exposure, maternal-child transfer via placental exchange or breast milk
HIV Infection Control Good hand washing, Do Not recap used needles, Use of gloves when handling body secretions, Disposal of contaminated materials
HIV acute inf stage Flu-like syndrome, Acute retroviral syndrome, cold or flu, self-limiting
HIV early chronic inf stage Asymptomatic disease, vague symptoms persist Median interval between infection and diagnosis 11 years
HIV Intermediate chronic inf stage early symptoms become worse, thrush, shingles
Late chronic infection or AIDS CDC criteria Opportunistic infections and cancers
normal function of T-calls immune system function. norm>500. <200=aids. HIV uses T-cells to replicate
The amount of virus per milliliter of blood VIRAL LOAD. The higher the viral load, the higher the risk of disease progression and/or death. low risk<10000. high risk>50000.
The CD4 count tells you the distance to the cliff. The viral load gives you the speed of the train. Antiretrovirals (ART’s) are the “brakes” for this train.
HIV Encephalopathy Brain invaded with virus, 60% of AIDS patients, neurological symptoms (impaired memory, slowness of speech, loss of function, loss of mental process)
HIV meds Nucleoside Reverse Transcriptase Inhibitors, Protease inhibitors, Nonnumcleoside Reverse Transcriptase Inhibitors, Fusion Inhibitor
Nucleoside Reverse Transcriptase Inhibitors: AZT -- malaise, HA, fever, nausea, vomiting, pancreatitis, neuropathy, oral lesions, rash, diarrhea, etc. Viread
Protease inhibitors Crixivan, Viracept, Norvir
Nonnumcleoside Reverse Transcriptase Inhibitors Rescriptor, Viramune
Fusion Inhibitor Fuzeon
CHALLENGES OF HIV MANAGEMENT Pill Burden, Food restrictions, Side Effects, Chronicity of the disease, Development of drug resistance, lipodystrophy Syndrome
HIV Dietary Recommendations Lean meat, high protein, high calorie, Six small feedings, High in vitamin A, Vitamin C, Beta carotene, supplements to diet
HIV CDC Guidelines Thoroughly cook meats, Avoid spoiled food, Reheat food well, Use bottled or distilled water, Do not leave food out of refridgerator more than 20 min. No unpasturized milk or cheese
Types of strokes embolitic, thrombolitic, hemorragic
embolitic stroke flows there, tissue dies, anticoags, heart holding blood (clots), activity onset, tpA.
thrombolitic stroke grows there, antiplatelet meds r used, preceded by TIA, slow onset of symptoms, happens in AM, tpA
hemmoragic stroke leak, have HA, from trauma, inc ICP, sudden onset, surgery to repair, get BP under control
#1 modifiable risk factor for stroke HTN management, smoking
3 main reasons a person seizes hypoxia, fatigue, alcohol, stress
period of fatique with reduced responsiveness post siezure postictal
how to report a seizure clear scene, time it, lay on ground, add o2, conscious or not??
absence seizure just stare off
grand mall, tonic clonic on the floor twitching
epilepsy recurring seizures
classic signs of parkinsons rigidity, brady kinesia, tremors, stoop, shuffles, pill rolling, lip smacking
myscemia gravis auto immune, causes breathing difficulties, slowly dec, muscle probs, exhaust easily, removal of thymus gland, can paralyze resp muscles
MS many plaques on nerves, remission/exacerbations, muscle, motor, urinary, sexual, emotional, cognitive impairments
ALS (amyotrophic lateral sclerosis) 20-40 yo, no confusion, cant swallow, breath or eat.
Created by: vstein