NCTC 4th semester test 3
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| Guillain-Barre syndrome | Usually reversible and survivable
Is the leading cause of acute flaccid paralysis
most common presentation is characterized by ascending, symmetric paralysis that usually affects the cranial nerves and the autonomic nervous system
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| Guillain-Barre syndrome - Stages | Acute stage
can last up to 4 weeks
plateau stage lasting from a few days to a few weeks, in which signs and symptoms remain constant.
recovery stage, characterized by gradual improvement in signs and symptoms
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| What causes Guillain Barre Syndrome? | May experience onset of signs and symptoms 1 to 3 weeks after an acute viral infection that was respiratory or gastrointestinal (GI) in origin
Incidence increases generally with age, peaking most sharply from ages 50 to 74
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| Guillain Barre Syndrome s/s | Motor weakness and paralysis usually begin in the legs, progressing to the trunk and arms.
**Areflexia is considered a key assessment finding in GBS
Cranial nerve involvement is present in 85% of cases
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| Diagnostic criteria for GBS | progressive weakness of two or more limbs caused by neuropathy
* areflexia
* history of recent viral infection
* elevated protein levels in cerebrospinal fluid (CSF)
abnormal electromyography (EMG) results
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| Circle of Willis | where many arteries anastomose together at base of brain
Most common area for aneurysm formation, especially at midlife
Congenital malformation of this area in half human population
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| Cranial Nerve 1 | Smell - odor identification each nostril
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| Cranial Nerve 2 | Vision - Central, peripheral, light/dark, read words
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| Cranial Nerve 3 | Eye Motor - Move up/down/in, PERRLA, Raise eyelids, Constrict pupils
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| Cranial Nerve 4 and 6 | Eye Motor - Move eyes down/in (4) outward (6)
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| Cranial Nerve 7 | Face and Taste - Taste anterior 2/3 tongue, Make faces (smile, winch, puff cheeks, note symmetry)
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| Cranial Nerve 8 | Hearing - Acuity of words or tuning fork test
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| Cranial Nerve 9, 10 | Speaking - Swallowing, hoarseness, uvula symmetry, gag reflex
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| Cranial Nerve 11 | Shrug- Shoulder muscle strength
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| Cranial Nerve 12 | Tongue - Note deviation to one side, push tongue against cheek
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| Autoregulation | Brains are self-protective and attempt to prevent hyperemia or subflow states by regulating diameter of arterioles
Done by controlling pressure and chemistry
↑BP or ↓PaCO2 = constriction
↓BP or ↑PaCO2 = dilation
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| Cerebral Lobes - Frontal (motor strip) | voluntary motor, intellect, judgment, personality
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| Cerebral Lobes-Parietal (sensory strip) | sensory speech, sensory for opposite side of body
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| Cerebral Lobes - Temporal | (hearing, speech, emotions)
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| Cerebral Lobes -Occipital | (vision)
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| Cerebellum | Lies behind the brain stem (lower back of brain)
Motor center (muscle tone, posture, locomotion, coordination)
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| Autoregulation | Done by controlling pressure and chemistry
↑BP or ↓PaCO2 = constriction
↓BP or ↑PaCO2 = dilation
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| Possible Therapies for Increased ICP/Preventing Secondary Brain Injury | Positioning of patient
Maintain normal serum glucose
Avoid noxious stimuli
Avoid clustering activities
Avoid Valsalva maneuver
Avoid excessive suctioning
Maintain adequate oxygenation
Maintain PaCO2 between 35-40
Volume Resuscitation
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| Possible Therapies for Increased ICP/Preventing Secondary Brain Injury | Mannitol
May cause rebound effect in hours (increase in ICP after Mannitol wears off), so often given with Lasix
Observe for dehydration
Observe Na+, K+, Cl- levels every 4-6 hours
Must use IV filter with Mannitol, must be warm or will crystallize
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| Possible Therapies for Increased ICP/Preventing Secondary Brain Injury | Lasix
With Mannitol to pull fluid from vascular system into urine
May decrease CSF production
Induced Hypothermia after head injury
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| Possible Therapies for Increased ICP/Preventing Secondary Brain Injury | Drainage of CSF
Cerebyx or Dilantin IV
Diamox
Barbiturate Coma
Neuromuscular Blockers
Sedatives & Hyponotics
Nimotop
Steroids
Avoid vasodilatory drugs
Hypervolemia/Hemodilutional/Hypertension
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| Doll’s Eyes | Oculocephalic – evaluates brain stem function (nerves 3,6,8)
Briskly rotate head
Present (eyes should move in opposite direction of head)
Absent (eyes do not move in sockets but follow passively) indicates severe lesion of brain stem
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| Oculovestibular – evaluates brain stem function | Ice water into patient’s ear canal
Intact reflex (normal to have nystagmus, deviate toward the side with cold fluid and move away rapidly, nausea
Abnormal (asymmetrical movements)
Absent reflex (passive eye movements)
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| Intracranial Aneurysm/Subarachnoid Hemorrhage | Nimotop (Ca channel-blocker selective to intracranium) prevents vasospasm
Hypervolemia/hypertensive/hyperdilutional therapy (Triple H) includes Iv Fluids, Dopamine, Albumin or other volume expanders
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| Spinal Shock | Temporary flaccid paralysis and loss of reflexes below lesion
Hypotension and bradycardia and maintaining body heat are problems
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| Autonomic Dysreflexia | An over reaction to the sympathetic nervous system in patients with injury T6 or above
Check first for distended bladder or obstructed urine output
Check next for bowel distention/impaction
Elevated BP most threatening symptom
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| Precipitating Factors for Autonomic Dysreflexia | Scrotal compression, Epididymitis, Ejaculation, Sexual intercourse, menstruation, pregnancy, uterine contractions/vaginal child birth, vaginitis
Constrictive clothing/appliance, bone fractures, surgical procedures, pain, temperature fluctuations
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| Myasthenia gravis - Symptoms | weakness of the voluntary (skeletal) muscles worsens with activity and improves with rest.
Breathing difficulty because of weakness of the chest wall muscles
Chewing or swallowing difficulty,
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| myasthetnic crisis | life-threatening breathing problems.
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| Naegele’s Rule | (LMP - 3 months) + 7 days
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| Bipolar disorder | Lithium carbonate (Eskalith)
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| ADD/CNS stimulant | Methylphenidate hydrochloride (Ritalin)
Pemoline (Cylert)
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| Depression/tricyclic type | Amitriptyline hydrochloride (Elavil)
Nortriptyline hydrochloride (Aventyl, Pamelor)
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| Depression/MAOI | Phenelzine sulfite (Nardil)
Tranylcypromine sulfate (Parnate)
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| Depression/SSRI | Paroxetine (Paxil)
Fluoxetine hydrochloride (Prozac)
Sertraline hydrochloride (Zoloft)
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| Depression/atypical or other | Venlafaxine (Effexor)
Bupropion hydrochloride (Wellbutrin)
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| The class of drug that is closely related to methylphenidate | Amphetamines
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| Condition exhibiting signs of both clinical depression and mania | Bipolar disorder
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| Enzyme that breaks down cathecholamine neurotransmitters in the synapse | Monoamine oxidase
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| Chemical found in medications that cannot be ingested by patients on MAOIs due to high risk for sever hypertension | Tyramine
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| Accumulation of serotonin when taking two drugs that reduce serotonin uptake | Serotonin syndrome
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| Psychosis/phenothiazine – lethargy with extrapyramidal se bone marrow supression | Thioridazine (Mellaril)
Chlorpromazine (Thorazine)
Prochlorperazine (Compazine)
Loxapine (Loxitane)
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| Psychosis/nonphenothiazine | Haloperidol (Haldol)
Thiothixene (Navane)
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| Psychosis/atypical | Olanzapine (Zyprexa)
Clozapine (Clozaril)
Risperidone (Resperadal)
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| Dopamine system stabilizers | Aripiprazole (Abilify)
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| Paranoid | An extreme suspicion that one is being followed, or that others are trying to harm oneself
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| Delusions | Firm ideas and beliefs not founded in reality
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| Hallucinations | Seeing, hearing, or feeling something that is not there
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| Positive symptoms | Symptoms that are added to normal behavior
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| Negative symptoms | Symptoms that subtract from a normal behavior
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| Schizoaffective disorders | A condition in which the patient exhibits symptoms of both schizophrenia and mood disorders
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| Neuroleptic | A term meaning “antipsychotic medications”
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| Anticholinergics | A class of drug that might be used to decrease extrapyramidal effects
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| Extrapyramidal effects | A movement disorder brought on by medication effects
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| Presumptive | no period
changes in breasts
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| Probable | enlarged abdomen
positive pregnancy test
goodall sign
chadwicks
palpable fetal outline
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| positive | see or hear fetus
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| when need to give rhogram | within 72 hours of exposure
28 weeks prophylacticly
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| Children vs adults Respiratory System Differences | Epiglottis located at level of cervical spine 1
Older child located at C3
Adult located at C4 to C5
Tongue large relative to head size; fills oral cavity
Infants obligate nose breathers until between 4-6 months
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| Infant/child usually experiences respiratory failure more often than primary cardiac failure | If cardiopulmonary failure usually tend to have bradycardia and apnea – not ventricular dysrythmias
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| Heart Failure - children | usually exhibit manifestations of both right- and left-sided failure
Infants exhibit change in responsivenss; lethergic, irritable, respiratory disgress with dyspnea; tachypnea, retractions, nasal flaring, grunting
Digoxin inotropic drug of choice
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| One Month | Physical
Gain 5-7 ounces weekly
Motor
Turn head
Sensory
Follows light to midline
Socialization
Utters small throaty sounds
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| Two to Three Months | Physical
Posterior fontanel closes
Motor
Can carry object to mouth
Plays with hands/fingers
Sensory
Listens to sounds
Socialization and vocalization
Smiles, laughs, shows pleasure with sounds
Cries less
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| Four to Five Months | Birth weigh doubles
Drools
Balances head when sitting
Reaches for and grasps objects
Rolls over
Recognizes familiar objects
Socialization and vocalization
Coos and gurgles
Enjoys social interaction
Vocalizes displeasure when an object is taken aw
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| Six to Seven Months | Physical
Teething may begin
Motor
Sit fairly well unsupported
Can transfer toys in hands
Plays with feet
Everything to the mouth
Sensory
Has taste preferences
Socialization and vocalization
Stranger anxiety begins
Laughs and cries easily
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| Eight to Nine Months | Motor
Develops pincer grasp
Crawls and creeps
Sensory
Interested in small objects
Socialization and vocalization
Reacts to adult anger
Uses vowels and consonants
“Dada”
Comprehends “bye-bye”
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| Ten to Twelve Months | Birth weight triples
Stands alone
Walks with help
Eats with a spoon
Plays pat-a-cake
Puts arm through sleeve
Shows jealousy, affection, anger
Explores away from mother
Security blanket
Knows name
Understands verbal requests
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| Hep B vaccine schedule | Birth
1 month
6 months
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| Toddler 15 months | Walks alone
Builds towels of 2 blocks
Enjoys throwing objects
Vocalization and socialization
10-15 words
“No”
Indicates when diaper is wet
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| 18 months | Abdomen larger than chest
Motor
Finger foods
Runs well
Vocalization and socialization
Temper tantrums
Very ritualistic
Favorite toy, blanket, etc.
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| Two Years and 30 Months | 26-28 pounds
32-33 inches
Walks up and down stairs
Controls spoon
Toilet trained in daytime
Uses pronouns
Obeys simple commands
Can help undress self
Increasing autonomy
Decreased need for naps
Independent, ritualistic, negative
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| Pre-School 3, 4, 5 years | Cooperative Play
Loosely organized group play
Learns to deal with reality, to control feelings, express emotions
Increased sharing and cooperation
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| Common Childhood Illness Cardiovascular Disorders Congenital shunts | Left-to-right because left usually functioning under higher pressure than right =Increased pulmonary blood flow
Right-to-left – cyanosis occurs
Treat with prostaglandin E1
Temporarily maintains patency of ductus arteriosus until surgery performed
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| Measles (rubeola) | Incubation 7-14 days; Koplik’s spots on oral mucosa (small, bright red spots with bluish-white speck in center; rash begins behind ears and spreads downward to feet
Needs respiratory isolation
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| German measles (rubella) | Incubation 14-21 days; infectious 10 days before onset of symptoms to 15 days after rash appears; airborne, direct contact with droplets, transplacental
Needs contact isolation
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| Mumps | Incubation 16 to 18 days but may extend to 25 days
Airborne droplets; saliva and possibly urine
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| Chickenpox | Incubation 10-21 days; infectious 1-2 days before onset of rash to 5 days after onset of lesions and crusting of lesions
Direct contact, droplet, airborne particles
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