med surge nursing
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| Ischemic Stroke s/s | numbeness weakness of face, leg, arm on one side of body
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| Hemorrhagic stroke | Exploding headache
decreased LOC
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| Aphasia | Receptive (Wernickes)
Expressive (brocas)
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| Middle Cerebral artery | Stupor
Coma
Hemiplegia
Aphasia
Contralateral drowsiness
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| Right Cerebral Hemisphere symptoms | unaware of limits
neglect syndrome
loss of depth perception
impulse
poor judgemetn
left hemipegia
hemianopsia
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| Left cerebral hemisphere symptoms | aphasia, agraphia (diff writing),
Right hemiplegia
Depression
Slow cautious behavior
Frustrations
Hemianopsia (blindness one sided in both eyes)
memory problems
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| Anterior Carotid Artery | loss descison making
loss voluntary actions
contralateral paralysis
urinary incontience
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| Internal Carotid | Most common
Hemianopsia
hemiplegia
aphasia
apraxia
agnosia
unilateral neglect
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| Veretbrae | Pain in face, nose, eyes
numbness
face weak-ipsilateral
dysarthia
gait problems
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| carotid endarectomy post op care | place pt flat or elevate HOB 30 degrees on unoperated side
support head to avoid rotation, flexing, extending
assess for hemorrhage, RESP distress, hyper/hyptoension
number one complication is stroke
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| TpA contraindication | after 3 hours
pt is on warfarin or INR above 1.7
recent head injury or trauma
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| Management of pt on Tpa | vitals q 15 min for first 2 hrs then 30 min for next 6 hrs
bo less than 180/105
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| S/s ICP | common in hemorrhagic strokes
caused by HTN
cerebral edema
hydrocephalus, vasospasm
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| Drug to control ICP | mannitol
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| Classic symptoms of Parkinsons | Need 2 out of 4 symp and + resp to park drugs
RIgidity- cog wheel(jerking movt)
Bradykinesia
Postural change
others included masklike expression, shuffling gait, dysphagia, wt loss, dementia
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| COmmon complications associated with Parkinsons | Resp tract infections
UTI
constipation
pain
sleep disorders
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| Sinemet and levadopa | precursor to dopamine, could wear off after years of therapy- not initaiated til moderate symptoms
Entracapone and talcopone prolong its effect
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| Neuroleptic Malignant syndrome | result of long term parkinsons drugs
severe stupor, rigidity, and hyperthermic
Hypomobility-inability to speak/walk--use apokyn to treat
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| Drugs to decrease tremors in parkinsons | antihistamines, beta blockers, and antivirals
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| Parlodel, Requip, Miroplex | parkisons drug used after sinemet is no longer effective
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| MS s/s | dysarthia, parastesias, intentional tremor, bowel. bladder dysfunction
exacerations/remissions
emotional disorders
weakness/paralysis
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| MS patho | unknown cause- in colder climates
impaired nerve imuples conduction due to destruction of myelin
-plaque on myelin
Autoimmune/viral
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| MS medication management | Muscle relaxants (Valim) decrease spasms
Steriods
Imuran/Cytoxan-immunosuppressants
Cholinergic-urinary retention
Interferon B- decreases exacerbations
Diazepam/Baclofan- decrease spasity
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| Management of MS | Void q 3hrs (self cath)
increase fiber, high protein, low fat, gluten free- raw veggies
megavitamins
Avoid laxatives and enemas
Cool environment
ROM q 2 times per day
Se
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| ALS | impaired impulse conduction d/t degeneration of motor neruons
muscle weaknes (begins in legs), atrophy, parlaysis
fatigue
resp failure
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| Management of ALS | riluzole-slows progression 2-3months
antibiotics propholactic
decrease pain, injury, risk of aspiration
ask for living will
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| Myasthenia GRavis Crisis | trigger by emotional distress, withdraw or infection
weak voice, unable to swallow, absent cough, increased Bp and HR, may need intubated
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| Cholinergic crisis in MG | n/v/d r/t overmedication, incresaed saliva and increased antibodies
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| Tenslon test | tensilon stops break down of ach
Used to dx myasthenia gravis
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| Mestinon | inhibits break down of ach for MG
S.e. cramps, n/v/d, excessive saliva
helps regain muscle strength
NEED ATROPINE as antidote
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| Management of MG | steriods-may initally worsen symp but then better- given indef
plasmaphoresis- removes plasma that contain antibodies (s.e. myasthenia crisis)
o2 may be needed
sit upright w chin down to eat
avoid hot/cold, infect, stress
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| Myastenia Gravis | autoimmune antibodies attack ach receptors
Profound weakness
fatigue
masklike expresion
diplopia, ptosis= droop of upper eyelid
diff swallowing/chewing
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| Gullian Barre | progressive demyelination of peripheral nerves from feet to head, numbness, tingling, autonomic dysfxn, autoimmune
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| Gullian Barre management | Intubation, plasmaphersesis, TPN, corticosteriods, turn q 2hrs, ROM, chest physiotherapy SCDs
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| Gullian Barre Dx | Increased protein in CSF nerve conduction slowed in EMG
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| TIC Douloureux | cranial nerve 5 (trigeminal nerve) sudden intense facial pain sudden eye closing
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| Management of TIC Douloureux | tegretol- monitor liver enzymes and bone marrow suppression; decrease neuro repolarization NARCOTICS do NOT work Antispasmatics (Baclofen, liorsal)
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| Rhizotomy | TIC Douloureux- destroys nerve recurrenses and complications are high
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| Education for TIC pts | test food temp before eating High cal, high protein, easy to chew use h20 jet instead toothbrush use artifical tears for eyecare
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| Bell's Palsy | Numbnessand tingling, Upward movt of eyeball Lag in closing eye Inflammation of CN 7 Unilateral facial weakness, difficulty eating, speech difficulties
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| Management of Bell's Palsy | Corticosteriods, heat therapy,
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