NUR 141 EXAM 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| for intestinal disorders you need to interrupt one of the following... | digestion, secretion, absorption, motility (segmentation (mixing), peristalsis (propulsion)), elimination
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| intestinal disorders occur d/t | inflam, inf, tumors, obstr, structural problems
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| manifestations of dysfunction | pain, hemorrhage, N/V, distention, constipation, diarrhea, abnormal fecal contents, incontinence
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| lactose intolerance | enzyme deficiency, missing lactace, afros and asians, undigested CHO
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| celia disease | automimmune damage to villi when gluten is consumed: wheat, oats, barley, rye
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| IBD | crohns and colitis
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| cystic fibrosis | genetic, mucus accumulation=pancreatic dysfunction, protein and fat digestion problems
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| steatorrhea | fatty stools
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| oxalates cause | kidney stones
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| inflam of hte gastrointestinal tract | gastroenteritis
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| gastroenteritis is caused by | inf organisms (virus, bacteria, parasites)
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| source of inf of gastro | contaminated food/water, contact w inf person, dirty utensils, fecal-oral,
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| patho of gastro | inflam alters secretion and absorption due to direct damage or production of toxins
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| s/s and dx of gastroenteritis | N/V, abd pain/flatulence, systemic fever, body aches, diarrhea, dehydration, electrolyte loss, stool
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| labs for dehydration | inc Hgb, inc Hct, inc BUN, inc Creat
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| labs for stool | ova/parasite, culture, WBCs, or toxins. test takes days d/t normal flora in stool
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| major health care associated inf | C. diff (clostridium difficele)
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| C. Diff occurs in.. | immunocompromised pt after antibiotic tx that destroys normal flora, spores last 70 days on surfaces
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| Tx for C. Diff | constact isolation, metronidazole (fLAGYL), vancomycin, stool transplant (not in immunocompromised)
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| diet for gastroenteritis | NPO until V stops, tx N/V, I/O, isolation, antibiotics, antimicrobials, no anti-diarrheals
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| IBS | chronic functional GI disorder, more in women
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| s/s IBS | abd pain, alternating diarrhea or constipation, flatulence, foul breath, N, anorexia, anxiety/depression, mucus stools
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| risks for IBS | stress, ETOH, smoking, lactose intol, specific food intol, psych factors
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| tx for IBS | high fiber (20gm), probiotics, low fat, no carb beverages or ETOH
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| meds for IBS | SSEI, loperamide (Imodium) for diarrhea, lubipostone (Amitzia) for constipation, alosetron (Lotronex) restricted access program
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| Inflammatory bowel disease | ulcerative colitis/chrones; chronic inflam of the GI tract, relapses/remissions, overractionto normal bacteria, 20yo and 60yo, genetic, more in whites
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| s/s of inflam bowel disease | diarrhea, bloody stools, wt loss, abd pain, fever, fatigue, skidney stones, liver disease, thromboembolism
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| complications of inflam bowel desease | hemorrhage, stricture/obstruction, perforation, fistula, colonic dilatation, nurtritional probs, sclerosing cholangisits, gallstones, liver failure
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| DX of inflam bowel diesease | labs, stool-+for blood, pus, mucus, signmoidoscopy, colonoscopy, EGD, barium enema, CT w contrast
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| IBD collaborative care goals | rest bowel, induce remission, , inflam control, correct malnutrition, reduce stress, stop smoking
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| meds for IBD | 5-aminosalicylate (saulfasalazine (Azulfidine)), antimicrobials, corticosteriods, immunosuppressants, biologic and targeted therapies, antidiarrheals (Imodium), hematologics and vit (iron, potassium, zinc)
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| nutritional therapy for IBD | fluid/electrolyte, high calorie, low fiber, residue, fat, small meals, no trigger foods, TPN
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| surgical intervention for chrones | common, high recurrence rate, short bowel syndrome, emergency situations
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| surgical intervention for ulcerative colitis | less common, total proctocolectomy is curative
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| dec freq, difficulty passing stools, dec volume, retained feces in the rectum | constipation
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| causes of contstipation | insufficient dietary fiber and fluids, dec physical activity, ignoring defecation urge, laxative abuse
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| causes of constipation related to age | dec secretion of digestive enzymes, dec muscle tone abd wall
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| s/s constipation | distention, bloating, flatulence, inc rectal pressure, hemorrhoid
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| related to venous engorgement with straining | hemorrhoids
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| related to Valsalva | cardiac problems
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| severe constipation, no stools/gas expelled | obstipation
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| accumulation of hardened stool that cant be expelled | fecal impaction-leaking of stool
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| tx for atonic constipation | high fiber, use natural foods, increase water intake , activity
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| diverticulosis | asymptomatice, seen w scope, high fiber diet, wt loss, no straining, tight clothes and lifting. no nuts/seeds
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| diverticulitis | pain, inc WBC, fever, CT scan, colon rest, NPO, IV fluids, progression of food first mush.
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| lesions of mucosal surface that progect into lumen of the bowel | colon polyp
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| non cancerous, limited growth | hyperplastic
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| linked to colorectal adenocarcenoma "mushroom" | adenomatous
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| third most common form of cancer in US, familia | colorectal cancer, second leading cause of death
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| risk factors for colorectal cancer | s/s dont appear until desease is advanced, obesity, smoling ETOH, large intake of processed meats
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| decrease risk for colorectal cancer | exercise, diet large mts of fruits, veggies and grains
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| s/s of colorectal cancer | pain, change in bowel habits, anemia, distention/obstruction, wt loss, N/V, black stools, blood in stool, hemorrhage
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| tx for colorectal cancer | resect tumor, restore bowel, ostomy, chemo, targeted biologics, radiation
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| targeted biologics for colorectal cancer | bevicizumb (Avastin)-prevents agiogenesis in the tumor, cetuximab (Erbitux) blocks epidermal growth factor receptor
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| skin assessment hx | onset/duration of problem, relationship (season, travel, etc), symptoms, hx oa associated illness
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| factors for assessment | good lighting, room comfortable temp, cosmetics removed, inspect mailbeds, oral mucous membranes on dark skinned pts.
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| decreased blood supply as in COPD, vascular disorders | cyanosis
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| vasicilation oas in fever cellutitis | flushing
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| skin lesion that drains from 1 hole, painful | furuncle
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| skin lesion that drains from any locations, usually staph, fever | carbuncle
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| purilant skin infection | pyoderma (pyo=puss)
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| furuncles/carbuncles need... | antibiotics and incision to drain
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| secondary skin inf | changes in skin due to scratching, irritation, inf, meds, invironment
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| blistering that is a response to a med | steven johnson
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| inflammation of subcutaneous tissue | cellulitis
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| s/s of cellulitis | hot, tender, red, edema, diffused borders
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| tx of cellulitis | moist heat, immobilization, elevation, antibiotic. can goto gangrene. no amb until under control
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| viral skin disease | very contagious, transmit easy, wore w immunosuppressed, avoid antibiotics (masks symptoms)
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| shingles | follows nerve pathways, pain before lesions, painful, fever, itch.
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| meds for shingles | Zovirax, Famvir, analgesics, steroids to relieve pain and itch
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| benign grown due to a virus | wart-verucca. bleeding can spread virus
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| skin fold appear moist and beefy red or brown, itch may have pustules on edge | fungal skin infections
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| tx for fungal skin inf | keep skin cool dry, leather, topicals
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| tenea capitis | craddle cap
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| candida | oral thrush
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| vitiligo | loss of skin pigment
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| chronic dermatitis, papular lesions with scalling borders, redness, mostly on scalp, elbow, knees | psoriasis
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| tx for psoriasis | UV light, tegison, methotrexate, corticosteroids
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| Tegison causes | birth defects, visual disturbances, hepititis
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| Methotrexate causes | liver toxicity, take no asprin
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| corticosteroids | apply after scales are removed, wet skin, cover w plastic
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| development of new pigment, sudden mole, loss/gain of hair, bleeding | seborrheic keratoses-mostly benign
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| tumor arising from melanocytes, metastasizes to any organ | melignant melanoma
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| gross distortion of reality, disturbances of language, communication, withdrawal, thought fragmentation | schizophrenia
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| s/s of schizophrenia | apathy, confusion, delusions, hallucinations, speech probs, bizarre behavior
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| persistent averant (incorrect) belief or perception that the pt cant b convinced otherwise despite of evidence to the contrary | delusional
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| sensory perception that doesnt result from an external stimulus in an awake state. auditory, gustatory, tactile, olfactory, visual | hallucinations
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| schizoid personality (schizophrenia phase 1) | loners, limited range of emotional expression, withdrawn
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| prodromal phase (2) | eccentric behavior, withdrawn, impaired role function, disturbances in communication, neglect of personal hygiene
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| schizophrenia (3) | delusions, hallucinations, disorganized speech, catatonic behavior
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| residual phase (4) | periods of remissions and exacerbations, depends on if they are taking meds or not
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| tx for schizophrenia | individual/group/behavioral therapy,
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| meds for schizophrenia | major tranquilizers, antipsychotic drugs. blocks dopamine in the brain
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| phenothiazines | thorazine, mellaril
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| thiozanthenes | navane
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| nonphenothiazines | haldol, zyprexa, resperdal
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| alteration in mood | depression
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| s/s depression | sadness, crying, withdrawn, cant concentrate, insomnia, anorexia, constipation, HA, fatigue
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| NS interventions | ask if they r thinking of killing self, make contract, meds, trust, make chage, set goals
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| anti depressio nmeds | effect neurotransmitter levels. MAOs, tricyclic antidepressants, slective serotonin, uptake inhibitors (SSRI),
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| MAOs | dont use much anymore, diet restrictions, many side effects
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| tricyclic antidepressants | Rememron, Desyrel
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| SSRIs | best ones. Clexa, Lexapro, Prozac, Paxil, Zoloft
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| Others | Wllbutrin, Cymbalta, Effexor
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| mood swings from profound depression to extreme euphoria (mania) | bipolar disorder
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| stage 1 | hypomania-good mood, helpful
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| stage 2 | everything is wonderful, euphoric, do inappropriate things, dec hygiene and sleep.
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| stage 3 | exaggerated mood swings, stooperous, confused, most unsafe
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| Ns interventons for bipolar | reduce stimuli, safety, calmness, set limits, meds
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| meds for bipolar | major tranquilizers, phenothiazines and lithium for the acute manic phases. can easily od on lithium
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| diffuse apprehension that is vague in nature and is associated with feeling of uncertainty and helplessness | anxiety disorder
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| affects ability to respond, more restless | moderate anxiety
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| unable to concentrate, cant complete task, HA, heart palpitations, insomnia, dread, horror | severe anxiety
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| unable to focus, hallucinations, delusions, withdrawn, confusion, feeling of terror, poor decisions | panic anxiety
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| anxiety disorder meds action | act at the limbic, thalamic and hypothalamic levels to produce calming
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| benzodiazepines | Xanax, Valium, Ativan
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| non-benzodiazepines | BuSpar, Atarax, Vistaril
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| others | tranquilizers
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| NS interventions for Anxiety disorders | any additional probs, what stressors, family support, accept, educate, coordinate care
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| assessment of suicide | elicit info, have a plan, hx of previous attempts, refuse to sign contract, live alone, ETOH, drugs, psychosis
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| Kubler-Ross stages of grieving | denial/isolation, anger, bargaining, depression, acceptance
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| 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
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| risk factors for complicated grief | sudden death, marked dependence, lack of support system, loss of a child, perception of preventable death
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| NS interventions for grieving | support, assess how pt reacts to loss, understand the normal grief process, assess s/s of maladaptive response
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| maladaptive response to grieving | preserving, intense/distorted occurrences, mental/physical disorders, suicide
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| 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
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| if an autopsy is to be done... | leave all lines in.
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| criteria for hospice | terminal illness, death within one year, DNR status
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| how to deal w death at work | get help, know your limitations, leave work at work
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| ascending symmetric paralysis that usually affects cranial and pereipheral nervous system | Guillain-Barre Syndrome
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| Guillain-Barre Syndrome | loss of mylein, edema, inflam of affected nerves that stops or slows nerve impulses
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| Guillain-Barre Syndrome occurs after a... | upper respiratory or GI inf-resp failure most serious
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| Dx for GBS | CSF-elevated protein, EMG-nerve and muscle function in affected extremities
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| NS management of GBS | monitor ascending paralysis, resp functin, arterial blood gases, gag and swallowing reflexes, BP, HR and rythm
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| amyotrophic lateral sclerosis | Lou Gehrigs desease-rare, loss of motor neurons resulting in degeneration of motor neurons in the brainstem and spinal cord.
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| s/s of ALS | weakness upper extremities, dysarthria(difficulty articulating words), dysphagia, muscle twitching, pain, spasicity, drooling,const, esophageal reflux
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| Dx of ALS | nothing rule out others
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| px of ALS | death in 2-6yrs from resp inf
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| disease disseminated demyelination of the nerve fibers of the brain and spinal cord. | MS-multiple sclerosis-disease of the young to middle aged adults.
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| Risk factors for MS | women (2-3x more than men), 5x more in US, Canada and Europe than tropical, family relative w MS
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| MS is marked by | exacerbations/remissions. attack of mylin sheath then regrow of. slerotic plaque on nerves
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| dx of MS | hx, physical exam, clinical mans, lesions in brain from MRI
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| teaching for MS management | avoid triggers, balanced exercise, rest and nutrition, no hot/cold climate, exposure to inf, fatigue, follow drug regimen
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| Chronic, progressive neurodegnerative disease | Parkinson’s Disease-Slowness in initiation/execution of movement, bradykinesia)Increased muscle tone.(rigidity)Tremor at rest.
Gait disturbance.
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| Clinical Manifestations of parkinsons | gradual/insidious, r/l sided, 70 yo, more males
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| Beginning stages of parkinsons | Mild tremor (first sign)
Slight limp,Decreased arm swing.
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| Later Stages of parkinsons | Shuffling Gait
Propulsive gait with arms flexed,Loss of postural reflexes,Slight change in speech
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| Tremors of parkinsons | First sign,Pt. may only notice,
Effect in handwritting,Aggravated by emotional stress,Tremors can involve:Diaphram,Tongue,Lips,Jaw
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| Rigidity of parkinsons | Second sign,Sustained muscle contractions,Muscle soreness,Feeling tired
Achy
Pain head, upper body, spine, and legs
Slowness of movement
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| Bradykinesia of parkinsons | Loss of automatic movements(involuntary),Stooped posture,Masked face,Drooling,Shuffling gait
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| 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
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| med for Parkinsons-levodopa/carbidopa (Sinemet) | Blocks the effects of the overactive cholinergic neurons.
Treats bradydinesia, tremors, and rigidity
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| Anticholinergics | Artane, Cogentin, Akineton. Treats tremors
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| Antihistamine | Benadryl
Treats tremors and rigidity
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| MOI | Eldepryl, Crebex, Azilect
Treats bradydinesia, tremors, and rigidity
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| disease that destroys the brain | alzheimers-60 yo, genetic, b-amyloid plaques, neurofibrillary tangles,
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| s/s alzheimers | subtle memory loss, final stage unresponsive, incontinent
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| 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.
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| 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
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| A stroke that a patient is able to fully recover from within a few weeks. | RIND Reversible Ischemic Neurological Deficit
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| 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
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| Risk factors for stroke | doubles each decade over 55yrs, more common in men, but more women die from it, African/ American, family history/heredity
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| modifiable Risk factors for stroke | Hypertension, Heart disease, Diabetes Mellitus, High cholesterol
Smoking,Alcohol,Obesity,
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| Results from bleeding into the brain tissue itself or into the subarachnoid splace or ventricles. | Hemorrhagic stroke
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| Results from inadequate blood flow to the brain from partial or complete occlusion of an artery. | Ischemic Stroke
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| 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)
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| left hemisphere stroke | right-sided weakness, receptive/global aphasia, dec decision making, cant see right in each eye(homonymous hemianopsia), behavioral changes, apraxia
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| aphasia traditionally associated with neurological damage to Wernicke’s area in the brain. language area | Receptive aphasia
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| inability to properly move the muscles of the tongue and mouth to produce speech. | Expressive aphasia
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| impairment of both comprehension and expression of language. often mute or reduced to a few stereotyped words or sounds | Global aphasia
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| Inability to perform learned movements despite having desire and physical ability to perform them. | Apraxia
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| a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system | Dysarthria
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| a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function. | Seizure
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| a condition in which a person has spontaneously recurring seizures caused by a chronic underlying condition | Epilepsy
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| involve both sides of the brain, Loose consciousness for a few seconds to several minutes. | GENERALIZED
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| occurs in children, staring spell | absence seizures
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| loss of consciousness and falling to the ground | tonic clonic
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| Dx of seizure | EEG
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| peculiar sensation that precedes a seizure | aura
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| interventions for seizure | ensure airway, protect from injury, time seizure, say w pt until gone, pt on side, remove tight clothing
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| drugs for seizure | anti-convulsived- Ativan, Valium, Tegritol, Felbatol
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| drugs given IV for staticus epilepticus (rapid acting) | Ativan and Valium
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| Don’t take with grapefruit, report visual abnormalities, abrupt withdrawal after long term use may precipitate seizures. | Tegritol
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| Use is limited. It can cause aplastic anemia and liver toxicity. Mostly used to treat patients who are resistant to other drugs. | Felbatol
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| (long acting) anti-convulsive durgs | phenytoin, phenobarbital, ethosuximide, lamotrigine, topiramate
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| Dilantin | good oral hygene, tack 2-3 hours of antacids, use additional contraceptive
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| LEADING CAUSE OF BLINDNESS WORLDWIDE! | CATARACTS:An opacity within then lens
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| NON-SURGICAL tx for cateracts | changing prescriptions, using magnifiers, increasing the amount of light, adjusting his/her lifestyle, reassurance
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| surgical tx for cateracts | NPO 6-8hrs, antibiotic drops, dilation of eye, removal of lens nucleus and coretex, corticosteroid drops
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| post surgical instuctions | no stooping, lifting, coughing, call dr for any drainage, analgesic for pain
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| FOUR DISEASES MOST COMMONLY CAUSING BLINDNESS IN OLDER PERSON: | Cataracts, Viral infections, Chlamydial infections, Glaucoma
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| Clinical Manifestions of cateracts | decrease in vision (gradual), abnormal color perception, and glare.
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| 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.
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| the outflow of aqueous humor is decreased in the trabecular mesh work. Most common type. | Primary open-angle glaucoma (POAG)
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| due to reduction in the outflow of aqueous humor that results from angle closure. | Primary angle-closure glaucoma (PACG)
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| clinical mans of Primary angle-closure glaucoma (PACG) | N&V, sudden, excruciating pain in/around eye, halos around lights, blurred vision, ocular redness
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| clinical mans of Primary open-angle glaucoma (POAG) | Tunnel vision (PAOG)
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| Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers | RETINAL DETACHMENT
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| CLINICAL MANIFESTATIONS OF RETINAL DETACHMENT | Photopsia (light flashes), floaters, “cobwebs”,“hairnets”,
Ring in the field of vision
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| The area of visual field loss is the center of the visual field (the macula) because of damage to the retina. | MACULAR DEGENERATION
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| Conductive Hearing Loss | cerumen (earwax build up, ear infection or sometimes tumors) to external/middle ear.
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| 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.
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| 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
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| Care of hearing aid | When not worn Remove or disconnect battery, Clean Ear molds weekly, ear tip w toothpick
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| determines hearing range of patient in terms of decibels (sound intensity), and Hertz (pitch) for diagnosis of conductive and sensorineural hearing loss. | Audiometry
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| can cause inconsistent results to audiometry | tinnitus
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| assessing vertigo ask... | hearing changes, dizziness or spinning, ringing in the ears, food allergies, staining during BM, changes in sleep, communication and during exercise
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| The cause is unknown but it results in an excessive accumulation of endolymph causing pressure in the membranous labyrinth (inner ear) | Meniere’s Disease
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| s/s of meniere's disease | severe attacks with nausea, vomiting, sweating and pallor, Tinnitus, fluctuating sensori-neural hearing loss, aural fullness.
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| 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
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| 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
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| Surgical interventions for meniere's | Decompression of endolyphatic sac and shunting, vestibular nerve resection, Labyrinthectomy
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| 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
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| Hydrops diet for meniere's | Restriction of sodium, caffeine, nicotine, alcohol and foods with MSG fluid buildups in the inner ear, lessen attacks
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| irritation of sensory branch of 5th cranial nerve | TRIGEMINAL NEURALGIA-in women >40, triggered by touch or temp
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| s/s of trigeminal neuralgia | intermittent, sudden-onset severe facial pain; unilateral; + blinking, tearing, jerking; unpredictable; clusters possible
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| tx for TN | antiseizure meds-decrease in neuron firing to block movement.
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| Cause: unknown, affects the motor aspects of the 7th CN (facial nerve), ? Inflammation RT Herpes virus | BELL’S PALSY
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| s/s of bells palsy | unilateral, drooping of mouth, eye rolls up when closing eyelid; can have difficulty with eating; tearing, lasts <6mtns
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| tx for bells palsy | MEDS: steroids, analgesics, eye protection
PT/OT
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| abnormal, excessive, involuntary movements | HUNTINGTON’S DISEASE -chorea
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| 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
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| s/s of huntingtons disease | progressive, death within 15-20 yrs
Abnormal muscle movement: voluntary & involuntary impacted
Emotional disturbances & personality change
Intellectual decline
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| 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
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| s/s of CREUTZFELDT-JAKOB DISEASE | RAPID PROGRESSION (wks to months)
Behavior and personality change
CNS: memory, vision loss, dysphagia, abnormal movement
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| dx of CREUTZFELDT-JAKOB DISEASE | autopsy
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|
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| bilateral, “pressing-tightening”, most common, mild-moderate; no triggering event. Duration 30 min – 7 days | tension HA
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|
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| - rare, repeated HA over weeks or months; “sharp/stabbing”; periods of remission; swelling around eyes; congestion or tearing | cluster
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|
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| recurring, often unilateral, “throbbing”; family tendency Improves with sleep. Can have N & V, photophobia and be preceded by prodrome. | migraine
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|
||||
| 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
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|
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| brain tumor arises from tissues within brain | primary
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|
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| brain tumor metastatic, most common | secondary
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|
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| s/s of brain tumor | HA, N & V (inc. ICP), Behavior change,Muscle weakness, Seizures, cognitive problems(Memory,Personality & mood)
Sensory losses,Hydrocephalus
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|
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| tx of brain tumors | Surgery, Radiation, Chemo, Symptom management: shunts
🗑
|
||||
| alterations in thought, acute, shorterm | confusion
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|
||||
| 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,
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|
||||
| 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
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|
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| Computer-assisted xray of multiple cross sections. Noninvasive. | CT-Computed tomography-Some studies will utilize IV contrast media.
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|
||||
| 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.
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|
||||
| 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.
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|
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| 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
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|
||||
| 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:
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|
||||
| loss of equilibrium, physical and mental illness, loss of identity and self-esteem | MALADAPTATION
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|
||||
| Compensation | making up for a deficiency by emphasizing a feature considered an asset.
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|
||||
| Conversion | unconsciously repressing an anxiety producing emotion conflict and causing difficulty sleeping, loss of appetite etc....
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|
||||
| Denial | avoiding emotional conflicts
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|
||||
| Displacement | transferring anger over an interpersonal conflict to a malfunction VCR
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|
||||
| 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
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|
||||
| 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
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|
||||
| 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.
🗑
|
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