Chapter_29_Prep-U - 1) Upon reviewing the client's medical record, the nurse finds the client has left ptosis. The nurse would assess the client for
This preview shows page 1 - 3 out of 8 pages.
tear replacement, plugs
the process of receiving data about the internal or external environment through the senses
cause symptoms as a result of pressure on adjacent structures or hormonal changes such as hyperfunction or hypofunction of pituitary; 10-15% of all brain tumors
Use an AED -try to use only one, -at lowest effective dose; -follow free serum drug levels (monitor levels during pregnancy) -try to keep them constant; -try to avoid valproate (most teratogenic) Risk of AED use during pregnancy << risk of seizures on fetus during pregnancy
Pre-pregnancy -- consider extra folate if taking AEDs (which often interrupt folic acid pathway)
Posterolateral cord Ipsilateral motor function
females: -amenorrhea -galactorrhea (excessive or spontaneous flow of milk) males: -impotence
-hypogonadism
Initially, led to big rash (starting pt on it too quickly) but if start pt on it slowly, less rash; careful of DDIs; Very effective
depends on the location of the injury and other unique factors. general complications include hypotonia, autonomic dysreflexia, spinal shock, orthostatic hypotension, bradycardia, DVT, pressure ulcers, pain, limited chest expansion, pneumonia, stress ulcers GI, urinary incontinence, neurogenic bladder, UTIs, impotence, decreased vaginal lubrication, join contractures, muscle spasms, muscle atrophy, pathologic fractures, hypercalcemia spinal shock: temporary loss of reflex activity below the level of spinal cord injury, this usually happens 30-60 min after a complete SCI. There is loss of motor function, sensation, spinal reflexes, and autonomic function. other manifestations include bradycardia, hypotension, loss of sweating and temp control, bowel/bladder dysfunction, flaccid paralysis, loss of ability to perspire. could last from days to months before reflex activity returns.
within the first year of injury even, the patient is at risk for spinal shock whenever they are moved.
destruction of meylin sheaths in axons of PNS= poor conduction of nerve impulses=sudden muscle weakness, loss of reflex response. result of humoral and cell-mediated immunologic responses.
avoid eye strain, avoid rubbing eyes, contact MD about decrease in vision, severe eye pain, increase in eye discharge, take measures to prevent constipation; mild itching is normal
complex problem solving, value judgements, language, emotions, visual image interpretation, touch, pressure, and temp
3. Keep the room organized and clean; A disorganized, cluttered environment increases confusion.
Keeping the room well-lit during waking hours (option 1) promotes adequate sleep at night. It is important to eliminate unnecessary noise (option 2). Client does not meet the standard criteria for restraint application (option 4).
1. Risk for injury; The nurse determines what effects peripheral neuropathy will have on the client. Swallowing takes place in the posterior pharynx and esophagus. This is centrally located; unrelated to peripheral neuropathy. Fluid overload is related to excess intake relative to output, or organ failure such as heart failure, not sensory perception. It is unlikely paresthesias would cause social isolation.
Approved for: -Absence (failed ethosuximide) -Myoclonic -Akinetic Side effects:
Thalamocortical circuits going "haywire" eg. seizure due to cocaine use (hits throughout the brain)
by hands
Corticospinal Spinothalamic
Posterior columns
deprivation
...
-named by the most caudal neurologic level with AT LEAST 3/5 muscle strength (can resist gravity)
Normal Saline
•Motor nuclei of the cranial nerves are most affected (lower motor neuron) •Patients often present with slurred speech and difficulty chewing and swallowing •Exam: drooping of palate, depressed gag, pooling of saliva, wasted, fasiculating tongue
•All cranial nerves have bilateral innervation except: Half of CN7 & CN12
paralysis, decrease in ADL's, aspiration, loss of verbal communication, pneumonia, resp failure, malnutrition, depression.
Low
Pilocarpine( Isopto Carpine, Pilocar), Timolol maleate (Timoptic), Carteolol (Ocupress), Acetazolamide (Diamox). Epinephrine does reduce aqueous humor produciont; however, it dilates pupils. mydriasis reduces aqueous humor outflow, which is dangerous for clients with angle-closure glaucoma.
notify the surgeon. these are signs of increased intraocular pressure or hemorrhage. the surgeon should be notified immediately.
Teaching prevention to avoid head injury is key.
1.Reposition the client on a regular schedule as dictated by individual situation. ® Allow proper blood circulation, prevents venous stasis and formation of decubitus ulcers 2.Place patient on moderate high back rest position with head at the midline ® allows greater lung expansion and prevent compression on the diaphragm from prolong bed rest. 3.Support body part especially the affected side using pillows or rolls ®Prevention from developing pressure ulcers particularly on bony prominences 4.Keep body aligned and place extremities in proper position ® Proper positioning and turning maintains joint function and prevents contractures. 5.Perform active range of motion on unaffected extremities and passive range of motion exercises on affected extremities every 4 hours. ®Active range of motion exercise improves muscle strength while passive range of motion exercise improves joint mobility 6.Encourage patient to perform certain movements according to ones capability such as moving left upper and lower extremities, moving tongue, and moving head. ®To maintain strength and integrity of the functioning body parts. 7. Raise the siderails and provide a responsible watcher. ®weakness and loss of body coordination are at risk for fall or accidents. 8.Provide enteral feeding via NGT ®Provision of nutrition for metabolic and energy demand. 9. Perform regular skin care. (e.i sponge bath,apply lotion) ®Maintains skin integrity and decreases risk for skin breakdown. 10.Schedule activities with adequate rest periods ®To reduce fatigue and decrease energy demand 11. Provide a positive atmosphere while acknowledging ones difficulty.
®Helps minimize frustration and rechannel energy.
2. Will report pain at 4 or less on a 10-point scale; People who have sensory overload may appear fatigued. They cannot internalize new information and experience cognitive overload as a result of everything that is happening to them. Such factors as pain, lack of sleep, and worry can also contribute to sensory overload.
typically occurs in kids from 6-36 months
•Mixed upper and motor neuron deficit in the limbs •Sometimes there is cognitive decline (fronto-temporal dementia) •Also associated with pseudobulbar affect or parkinsonism •Progressive - fatal within 3-5 years
•Patients with bulbar involvement have poor prognosis
Osmotic diuretics and iredectomy (removal of part of the iris) MANITOL
The pt is at high risk for depression and self-injury because he is likely to lose function below the umblicus . resulting in loss motor function. In addition he will need to be in a wheelchair, impaired sexual function, and can not use tobacco, alcohol, marijuana abuse for coping. The answer is B
- 5 to 10 y/o - hemifacial twitching and drooling esp at night
- rx = AED (if needed) and resolves by teen years
narrowed spinal canal, hyperextension injury
First in the newer generation of drugs; Not as great as the others (efficacy) but no DDIs and less S/E; often use in pt w/ transplants; facing S/E
a daily routine that they can count on, everything familiar to them has one place inside of their room, encourage as much self-care as possible, demonstrate use of equipment, modify clothing with Velcro and lay out daily clothing, encourage "finger foods" during meals.
Ginko Biloba seems to improve memory. Antioxidants such as Vit-C, Vit-E, and coenzyme 10 may slow progression. Huperzine A, a traditional Chinese medicine, acts as an acetylcholinesterase inhibitor, encourage fluids and fiber.
The warning signs of a TIA are exactly the same as for a stroke. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination
A thorough review of the dosage regimen, possible adverse drug reactions, and early signs of bleeding tendencies help the patient cooperate with the prescribed therapy. Teach: -Follow the dosage schedule prescribed by the PHCP, and report any signs of active bleeding immediately. (gums bleeding, bruising, bloody stools, black and tarry stools, vomit that is bright red or looks like coffee grounds). If these are found, d/c the next dose and contact your PHCP immediately. -The INR will be monitored periodically. Keep all appointments, because dosage changes may be necessary. -Do not take or stop taking other drugs except on the advice of the PHCP. -Inform your dentist and other PHCP of therapy. -Take the drug at the same time each day. -Do not change brands of anticoagulants without consulting a physician or pharmacist. -Avoid alcohol unless use has been approved by the primary health care provider. -Be aware of foods high in vit-K, such as leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt. Maintaining a healthy diet including these foods may help maintain a consistent INR value. -Keep in mind that anti-platelet drugs can lower all blood counts, including the WBC count. Patients may be at greater risk for infection during the first 3 months of treatment. -Use a soft toothbrush. -Use an electric razor when possible.
-Wear or carry medical identification.
place client in upright positon for meals and 30 minutes afterward. tild head slightly forward. do not feed client who does not have functioning gag reflex or has altered LOC. provide oral care before meals. serve thickened liquids and pureed or soft food and place foods on unaffected side of mouth. limit distractions at meal time. have suction equipment available during mealtimes.
• no drug interactions • non-hepatic metabolism • easy to load orally
• very safe, well tolerated
Most common type of brain tumor; Arise from the meninges Firm, encapsulated, extremely slow growing; Can become quite large before causing symptoms; surgical resection
chronic demyelination of CNS. onset 20-40 yrs old. Mostly Northern European ancestry, those living in Northern Climates.theory= immune response to protein in CNS
Fractures
a sign of posterior column damage in the spinal cord. Is characterized by flexion of the neck produces a sensation like an electric shock running down the spine and into the LE.
pain with movement of the eye, increased tearing, redness of the conjuctiva
1. Spells must be epileptic 2. Seizures must be focal (partial) a. All seizures must have the same focus
3. The focus must be in a region of brain that can be safely removed
hold next dose immediately, call PHP if bleeding will not stop after 10min of pressure if external, be prepared to administer antidote, FFP, or other drugs as ordered by PHP.
Among the manifestations of autonomic dysreflexia are hypertension (up to 300 mm Hg systolic) and a throbbing headache. Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic. Points Earned: 1.0/1.0
Correct Answer(s): A
4. An 80-year-old client admitted for emergency surgery; A sudden, unexpected admission for surgery may involve many experiences (e.g., lab work, x-rays, signing of forms) while the client is in pain or discomfort. The time for orientation will thus be lessened. After surgery, the client may be in pain and possibly in a critical care setting.
Options 1 and 2 would more likely be at risk for sensory deprivation. Option 3 is considered a normal activity for most teenagers.
GI symptoms, severe muscle weakness, vertigo, resp distress. freq pt need ventilator assistance.
Atropine-bradycardia Vasopressor- dopamine (intropin) to improve pumping action of heart Heparin/Fragmin - prophylactic anti-platelet aggregation Ditropan -smooth muscle relaxant - bladder Detrol -smooth muscle relaxant - skeletal Cardur & Hytrin - alpha adrenergic blockers - for HTN & smooth muscle relaxant Liosresal - antispasmotics - muscle relaxant Reglan - promote GI motility Proton pump inhibitors - dec. acid avoid stress ulcers H2 receptor blocker - dec. acid avoid stress ulcers Solumedrol - steroid to reduce inflammation—Not with penetrating spinal injury, give within 8 hrs of event, dec edema/inflammation, inc blood flow. S/E dec. immune, GI bleed, infection
Procardia - vasodilator
may need enteral or TPN due to dysphagia. Need to positive nitrogen balance, hydrated, electrolytes balanced and sufficient calories
...
progressive disease from the onset with acute relapses with or without full recovery
centered on teaching about disease, psych support, genetic counseling,
Slow Loss of central/ near vision d/t aging retina Charted as ARMD
Maintain patent airway
characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.
Same risks and benefits as Gabapentoin though bit more S/E
excessive emotional reposnisveness characterized by unstable and rapidly changing emotions
The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix). Also maybe Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin. Ticlid is used when there is an aspirin allergy, are are used with aspirin in order to avoid clots from forming on coronary stents. Persantine is also an antiplatelet used. Anticoagulant drugs include heparin and warfarin (Coumadin). Heparin is used short term and warfarin over a longer term. These drugs require careful monitoring. If atrial fibrillation is present, may prescribe another type of anticoagulant, dabigatran (Pradaxa). Think +10 to differentiate PTT from PT. (C+O+U+M+A+D+I+N + 2. PT.) Vitamin K is the antidote for Coumadin, and Protamine is the antidote for heparin. Heparin should only be used parenterally. Lovenox is used instead of Heparin during pregnancy (does not pass the placenta) and is more long term than Heparin, although not as long-term as Coumadin unless in a LTC. It is a type of Heparin.
All are used prophylactically for DVTs, PEs.
Corneal transplant
"you see at 20ft what the normal-sighted person sees at 30ft." The first number indicates the number of feet from the snellen eye chart that the client is standing, and the second number is the distance at which a normal-sighted person can read the line of the snellen eye chart.
Respiratory: Monitor resp status-accumulation of secretions: atelectasis, pneumonia, pulmonary embolus: Ventilation, suction, chest physiotherapy, assist cough, IS, eval O2, breath sounds, ABG's, sputum, resp. rate, effort: pain mgmnt; turning, sitting, exercising breathing muscles, ROM Cardio: CVP line; ECG, freq VS, Bradycardia (atropine, pacer), dec cardiac output, HTN Neurogenic Bladder - loss of muscle & neuro control; retention initially (r/t spinal shock l/t reflux of urine to kidney l/t UTI & kidney damage) followed by incontinence & spasticity r/t hyperactive bladder & sphincter: Foley, I & O, alert to UTI's-bladder control intermittent catheters q3-4 hrs preferred method, Older: prostate & renal calculi (r/t dec fluid) Remove Foley after initial period & go to intermittent cath. GI: Upper GI-swallowing, hypomotility (above T5) , gastric distention, stress ulcers: NG, NPO GI: Lower GI - neurogenic bowel (sphincters not working)-constipation, impaction: Bowel program (gastric callic reflex - 30-60 min after meal peristalsis increased and want to have a BM), rectal stimulant (suppository or enema) q day, inc fiber & fluids Nutrition: Wt. loss, anorexia, refusal to eat; inc protein & nutrious meals, inc protein, calories, fiber; TPN, tube feed, monitor e-lytes r/t NG l/t imbalance. Check albumin & e-lytes Integumentary: pressure ulcers (Life Threatening; can lead to sepsis)- position; turn; skin care; nutrition. Thermo regulation-paklothermia; hypo & hyper-thermia Always assume trauma patient has a spinal cord injury
Pin care: saline & antiseptic & antibiotic ointment. Monitor for s/s of infection. Traction weights hand freely/ never take traction off
nothing to treat specifically GB, treat other sysmptoms ie) UTI due to stasis in bladder, morphine for muscle pain, anticoags to prevent DVTs.
lung, breast, lower GI tract, pancreas, kidney, & skin (melanomas)
result of CVA
"Pink eye" inflammation of the conjunctiva
genetic testing.
Complete loss of motor and sensation below level of lesion acute:flaccid, areflexia
autonomic dysreflexia common precipitaing cause is distended bladder or rectum, although any sensoty stimulation amy cause autonomic dysreflexia. Immediate care : elevate hob to 45 degrees, sitting the patient upright perform an assessment to determine the cause and notify the physician.
DECREASE SALT INTAKE, decrease fluid pressure with diuretics, Surgery destroy the labynthisis,shunt,vestibular nerve section
condition in which swallowing is difficult or painful
Goal: Establish a pathology diagnosis and treatment plan Debulk tumor - take as much out as they can to help them return to better level of function
Glatiramer (MS, immunomodulator)
3. Awareness of a full stomach; Visceral refers to organs that may produce stimuli that make a person aware of them, e.g., a full stomach.
Maintaining a patent airway is the most important goal for a patient with a high cervical fracture. Although all of these are appropriate nursing diagnoses for a patient with a spinal cord injury, respiratory needs are always the highest priority. Remember the ABCs. Points Earned: 1.0/1.0
Correct Answer(s): D
MVAs, falls, violent assaults, sports injuries, IEDs at war. the cause is what influences the kind of head injury they have.
Incapacitating vertigo
Head Injury Hematoma CVA Tumors
Infections
Originate outside the brain; most common extra-axial tumors: Meningiomas, Schwannomas, Pituitary tumors
condition in which swallowing is difficult or painful
the client will have an inability to focus on objects up close such as print in a newspaper. often, the client will report a headache and eye fatigue with close work. instruct the client to hold reading materials at arm's length.
Correct Answer: C Rationale: The purpose of methylprednisolone administration is to help preserve neurologic function; therefore, the nurse will assess this patient for lower-extremity function. Sympathetic nervous system dysfunction occurs with injuries at or above T6, so monitoring of BP and heart rate will not be useful in determining the effectiveness of the medication. Respiratory and GI function will not be impaired by a T10 injury, so assessments of these systems will not provide information about whether the medication is effective.
The Glascow Coma Scale provides a quick guide for assesing LOC, It measures how well the pt responds to eye opening and verbal and motor responses.
jerking of the eyeballs
Preventing injury Monitor for decreased cerebral tissue perfusion. Preventing increased temperature Reducing headache
Decreases enviornmental stimulation
DOC=tricyclic anticonvulsant- carbamazepine (tegretol). other Dilantin, gabapentin or muscle relaxers- baclofen. SE= dizziness, N, Drowsiness. need to assess liver function, bone marrow and blood levels of meds.
...
• broad spectrum • doesn't alter other AEDs • weight loss
Disadv - slow to load; unresponsive
a technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain
masses composed of largely abnormal blood vessels found either in or on surface of brain; occur in cerebellum in 83% of cases; some persist throughout life w/o causing symptoms & others cause symptoms; pts are at risk for hemorrhagic strokes because blood vessel walls or angiomas are thin
...
intense paroxysmal neuralgia along the trigeminal nerve. results from demyelination of the sensory division of the trigeminal nerve and is characterized by stabbing short attacks of severe facial pain Eating, shaving or simply touching the face may elicit the response
Most common malignant brain tumor in children. Occur in the cerebellum.
ROM exercises to prevent contractures, use special appliances to help the child perform ADLs, provide protective head gear and bed pads to prevent injury, provide a high-calorie diet because the child will have a high metabolism rate due to high motor function, explain the disorder and treatment to the family and that efforts should be made to ensure that the child reaches the optimal developmental level possible.
Hair loss, Decreased WBC counts, Fatigue, Mouth sores, Decreased appetite, Nausea and vomiting (Side effects generally ease once treatment is over)
Sinemet: Dopaminergics - carbidoma-levodopa mixture. Levodopa is converted to doapaimine in the brain and carbidopa prevents levodopa from being destroyed. Comtan is used in adjunct to Sinemet sometimes. Enhances Tasmar: last resort Dry mouth/difficulty swallowing, anorexia, nausea, diskinesia vomiting, abdm pain and constipation, increased hand tremor, headache and dizziness. Caution should be used in combination with opioids, antacids, anticonvulsantsm and tricyclic antidepressants.
Choreiform movements and dystonic movements are the most adverse reaction to levodopa.
Prothrombin time (PT) and the international normalized ratio (INR) are used to monitor the pts response to warfarin therapy. The daily dose is based on these labs. Therapeutic range of the PT is 1.2 to 1.5 times the control value (11-13 seconds, think "pre teen"). INR should be maintained between 2 and 3. The The Activated Partial Thromboplastin Time (APTT) determines the overall capacity of the blood to clot for pts on heparin. 1.5-2.5 the control value (25-45 seconds, think "prime teaching time"). The APTT needs to be drawn q6hrs, heparin has a short half-life and so the amount can vary greatly within a short period of time.
If the numbers are too low, they are at risk for clots. If too high, then they are at risk for bleeding. There is a narrow therapeutic range for anticoagulants.
for acuity
Benign "rolandic" epilepsy -Simple partial seizures with abnormal movements and sensation of the mouth, sometimes the hand, with excessive salivation and drooling -May have secondary generalization
-Typically present at age 5-10 yrs, almost always resolve by age 18
10-15mmHg
smiling, frowning, and raising the eyebrows
Insulin, diet
Treatment of this tumor consists of surgical resection, May also involve shunt placement and radiation therapy, Prognosis is excellent with surgical resection
loss of bodily sensation with or without loss of consciousness
H&P, tensilon tests, nerve stimulation studies and analysis of antiacetycholine receptor antibodies.
provide a private room and limit stimulation. minimizing stimuli will assist the client experiencing sensory overload. immediately completing a thorough assessment will overwhelm the client at this time; therefore, brief assessments done over the course of the shift are preferred. rooming with a roommate who is hearing impaired and/or talking in a loud voice will increase environmental stimuli.
abnormal, unpleasant sensation [burning, numbness, pins and needles, tingling]
•Common neurologic disorder •Likely autoimmune; Genetic susceptibility •More common in Western-European descent who live in temperate zones (unheard of in the tropics, but they have more parasites) •Focal, often perivenular lesions of demyelination with reactive gliosis are found in the white matter of the brain, spinal cord and optic nerves
•Axonal damage
a. sleepiness b. nausea c. dizziness d. diplopia e. ataxia f. headache g. rash (**)
h. TERATOGENICITY! (esp valproic acid)
Gamma knife radiosurgery (preferred treatment for symptomatic lesions); Open surgery for lesions >3 cm; Occasionally complete resection is not possible; consider other treatments
antibiodies destroy or block neuromuscular junction receptor sites, decreasing the number of acetylcholine receptors. Net result is decrease in muscles ability to contract.
chronic condition of inner ear too much endolymph, no known cause
-"flexor posturing" or "mummy baby" (think Egyptian mummy preservation) -adduction of arms (arms fold to chest); flexion of elbows and wrists
unexpected
affected limb hanging from bed. client with severe PAD may find comfort with the affected limb in a dependent position.
Distal symmetrical motor weakness, Mild distal sensory impairments, Transient paresthesias, Weakness progresses from LE to UE, Symptoms peaks within two-four weeks, MM and respiratory paralysis, Absence of DTR, Inability to speak or swallow - Can be life threatening if respiratory system is compromised, 30% of acute on a respirator, Acute onset in 2-4 weeks, f/b 2-4 weeks of static symptoms, gradual recovery over weeks and years
Sudden decrease in muscle tone -> loss of postural control -> patient may fall ("drop attack")
Urinary retention, Fecal incontinence & SADDLE hypOesthesia -pain/loss of sensation in the SADDLE distribution of the perineum
Autonomic dysreflexia is related to reflex stimulation of the sympathetic nervous system reflected by hypertension, bradycardia, throbbing headache, and diaphoresis. Points Earned: 0.0/1.0
Correct Answer(s): D
...
The inability to control the range of a movement and the force of muscular activity.
Beta blockers, Miotics, carbonic anhydrase inhibitors (to cause pupil constriction and drainage) DIAMOX
Teach safety! Patient learns to walk again when shuffling (draw imaginary life and have them follow it. Life entire foot and do "u-turn"). Exercise very important, helps them gain control again (swimming, biking, yoga, dance).
Teach about psychological support, respite care, community resources such as home health agency, meals on wheels, elder care, sources for special adaptive equipment, support groups and stroke clubs.
Monitor temp frequently Cooling blankets Tylenol, NO ASA. Higher dose of drugs & fluids Assess LOC frequently Restful environment Airway & Oxygen (resp failure)
Vitals & cardiac monitoring
1. syncope - warning of lightheadedness (eg sudden emotion) but no other manifestations 2. movement disorders - usually ongoing and variable duration; NOT STEREOTYPED 3. Sleep disorders - occur in spec phases of sleep 4. TIAs - usually negative sx 5. Migraines - longer duration, often w/ headache
6. Non-epileptic spells (less stereotyped, more variable than seizures, bilateral movements, asynchronous limb movements; side to side head turning)
commonly trauma
penetrating injuries, tumors, disc disease,
thicken liquids to the consistency of oatmeal. place food on the unaffected side of the mouth. allow plenty of time for chewing and swallowing. teach the client to swallow with the head and neck flexed slightly forward. monitor the client's swallow and gag reflexes prior to starting dietary intake.
unexpected
rule out possibility of Arnold Chiari malformation (parts of cerebellum and lower brainstem are displaced inferiorly causing mixed pyramidal and cerebellar deficits in the limbs).
familial *chromosome 5.
Frequent vitals allows the LPN to report and changes in the vitals immediately to HCP. It also allows nurse to identify the types of interventions the patient may need.
Complex kinetics - from right below therapeutic level then shoots up way beyond) - could make someone v. toxic quickly ⇒ serum level starts to rise exponentially after reaching a certain dose (different dose for different people)
Riluzole: antiglutamate. Inhibits presynaptic release of glutamic acid in CNS and protect neurons. Monitor for liver function, blood count, alkaline phosphatase.
Staggering, Wide BOS, Poor foot placement, Slow uncoordinated progression of LE, Poor ability to produce reciprocal movement
Severe cognitive decline; moderately severe or mid-stage AD; memory difficulties continue to worsen loss of awareness of recent events & surroundings; may recall own name, but unable to recall personal history; significant personality changes are evident (delusions, hallucinations, & compulsive behaviors); wandering behavior; requires assistance w/usual daily activities such as dressing, toiling, & other grooming; normal sleep/wake cycle is disrupted; increased episodes of urinary & fecal incontinence
1- unilateral shaking or tremor of one limb 2- Bilateral limb involvement occurs making walking and balance difficult 3-Physical movements slow down significantly, affecting walking more 4-Tremors may decrease but akinesia and rigidity make daily to day tasks difficult
5-client unable to stand or walk, is dependent for all care and
Pressure ulcers (decubitus) Venous stasis --> dvt & pe
Pulmonary function decreased d/t positioning
place a vibrating tuning form on the midline center of the client's head. instruct the client to state in which ear the sound is the loudest. a normal findings is no lateralization of equal sound in both ears. lateralization to the affected ear is consisten with conductive hearing loss, whereas lateralization to the unaffected ear is consistent with sensorineural hearing loss.
ABC+R - Avonex, Betaseron, Copaxone. All for relapsing and/or reducing lesions.
Can cause acidosis so increased risk of kidney stones; wt loss (popular) BUT can cause memory loss esp words
-assesses blood flow; involves catheter insertion, dye injection and sequential x-ray -know if pt has allergy to shellfish, iodine or has blood clotting disorder; these allergies require different contrast media
-observe for catheter site bleeding 8-12hrs postprocedure
anticholinesterase 30 mins prior to meals.
reporting a burst of black spots. a sudden onset of flashes of bright light of dark floating spots "floaters" in the affected eye is a classic sign of detachment. there are no pain fibers within the retina so no pain is generally experienced.
the client will experience loss of central vision and will only be able to see peripherally.
ESR: elevated due to synovitis Radiograph: structural changes
Tympanic membranes are pearly gray and intact. light reflex is visible in a well-defined cone shape. umbo and manubrium landmarks are readily visible. ear canal is pink with fine hairs.
glial cells (cells that make up structure & support system of brain & spinal cord) & are supratentorial (located above covering of cerebellum)
Medication that decreases breakdown of levadopa making more available to brain for dopamine. Monitor for dyskinesia, hyperkinesia, diarrhea. Dark urine is a normal finding.
Loss of vision in half of the visual field on the same side of both eyes
the assessment to determine the level of spinal cord injury includes analyzing the -vital sign, plantar reflexes, bilatereal hand grasp, description of trauma. Romberg test must be performed while standing therefore not suitable for unstable patient
Answer: a, c, d, e
a bowel program should be started during the acute phase.
any of many types of loss of neurological function associated with interpretation of sensory information
Myopia
inflammation of the inner ear, fullness, severe deep trobbing pain, hearing loss, tinnitus, fever are all sx ; myringotomy local heat are some tx
a disorder involving the relationship between nerves and muscles, and especially the weakening or dysfunction of muscles.
sudden exacerbation of motor weakness= resp failure/ aspiration. caused by undermedication/ infection.
triad of hypotension, bradycardia, and hypothermia
...
dysfunction of upper motor neurons= spastic weak muscles w/ increased deep tendon reflexes. dysfunction of lower motor neurons= muscle flaccidity, weakness, paralysis, atrophy.
slurred speech.
1. Focal - initial activation in 1 part of brain (EEG and clinical) 2. Generalized - initial involvement of both hemispheres
progressive muscle atrophy caused by hardening of nerve tissue on the lateral columns of the spinal column (Lou Gehrig disease)Chronic Degenerative Disease UMN and LMN impairments. Rapid degeneration and demyelination of the giant pyramidal cells of the cerebral cortex
MAINTAIN: a patent airway***** adequate ventilation and adequate circulating blood volume, and preventing extension of cord damage
Correct Answer: B Rationale: The nurse has identified that the cough effort is poor, so the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia, and oxygen will not help expel respiratory secretions. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.
a familiar object placed in his hand. Identifying a familiar placed in the hand assesses for stereognosis. graphesthesia is identifying a number drawn in the palm of the hand. hearing whispered words tests CN VIII. Identifying a vibrating tuning fork tests the vibratory sense.
Ask family what the patient's baseline is Assess LOC, and orientation, if pt is unconcious use the Glascow Coma Scale Assess for numbness and tingling in extremeties Determine if pt has difficulty with sensory functions Assess strength of hands grip and movement of extremities Assess pupils using PEERLA
Obtain past medical hx
Trach kit
10%
Whisper test.
Rare, but fatal complication of hyperthyroidism Reduce body temp and heart rate Fever 100-106 Tachycardia >140 bpm Hot, flushed skin Anxious
Diarrhea, nausea
-Riluzole 50mg BID reduces the presynaptic release of glutamate, may slow progression of ALS -Monoclonal gammopathy (increased IgG) - may benefit from plasmapheresis or immunosuppression -Symptomatic treatment with anticholinergic drugs dries up oral secretions
-Spasticity may be helped by Baclofen or Valium
Approved for: -Focal -Generalized tonic-clonic -Juvenile myoclonic epilepsy Side effects:
BL vision 20/100. nearsightedness (myopia) is a risk factor for retinal trauma and consequently retinal detachment.
• Defn: Recurrent seizures that aren't stopping; If seizure persists for more than 5 minutes, likely to continue - this is status epilepticus • Most seizures resolve spontaneously in 45-90 seconds; no acute treatment necessary (except to turn patient on side if possible to reduce aspiration risk) - DON'T put tongue blade or anything else in mouth
Assessment/Diagnosis: Head CT, lumbar puncture, neural assessment; Treatment - supportive care
-months to years between initial episode and new symptoms or recurrence --Eventually there are relapses and incomplete remissions leading to progressive disability -Weakness, spasticity, ataxia of limbs -Late findings include •Optic atrophy, nystagmus, dysarthria
•Pyramidal, sensory or cerebellar deficits in some or all of the limbs
Used for alternative ways to handle ADLs (dress in slip on clothes and shoes, no buttons). Also, how to use utensils to eat.
• Complex kinetics - as increase dose, blood level rises gradually until takes off (see graph) • Many drug interactions
Mild itching is normal, pain is a problem. Reduce IOP Prevent infection Assess for bleeding Teach pt to report any changes in vision to dr Avoid activities that can increase IOP
Proper eye drop admin
during spinal shock neuromuscular function is lost below the level of the injury along with hyporeflexia and loss of sensation. So the pt will not be able to sit until the pinal shock resolves. Answer : C
age 85, antibiotic therapy with reduced renal function, employed as a ground crew member at a large airport, presbycusis, high doses of IV furosemide (lasix) for congestive heart failure exacerbation, chronic use of NSAIDs for rheumatoid arthritis management.
Gag reflex
-anything <=8
Primarily motor seizure that begins in one focus but then spreads throughout the cortex -Often secondarily generalizes -> loss of consciousness and possible GTCS
-Most often starts in the hand; face may be involved early
Take early morning on empty stomach Take at least 4 hrs apart from other drugs: antacids, and iron. Take at the same time every day.
Measure pulse twice weekly report if >100.
=the presence of motor function OR sensation at the anal mucocutaneous junction -can be complete or incomplete (partial)
Infection (pulmonary) Sepsis Diabetes Stress Trauma or surgery
Abrupt withdrawal from thyroid meds
Medication that helps control tremors and rigidity. Monitor for signs of dry mouth, constipation, and urinary retention
Increased T3 & T4 Decreased TSH
hearing loss at birth
Scrimers Test (tear test)
a. ABC (airway/breathing/circulation) b. IV lorazepam, 0.1 mg/kg (a benzodiazepine) c. IV fosphenytoin (pre-cursor of phenytoin) (if available; otherwise, IV phenytoin) d. If still seizing: more fosphenytoin
e. If still seizing: add another agent - may need to start thinking about inducing coma
Cool, quiet environment Promote sleep Cool showers & linen changes High calorie/protein diet Extra fluids, no caffeine or fiber
Eye care
Correct Answer: D Rationale: The patient with a C6 injury will be able to use the hands to push a wheelchair on flat, smooth surfaces. Because flexion of the thumb and fingers is minimal, the patient will not be able to grasp a wheelchair during transfer, drive a car with powered hand controls, or turn independently in bed.
drugs - osmotic/loop diuretics, elevate HOB 30 degrees, midline position, o2 as ordered, avoid hip flexion and abdominal distention (stool softeners as ordered), monitor temp q2hrs for hyperthermia (no rectal temps), reduce stimulation of environment, turn client gently, limit fluid over 24hr period. barbiturates is used to induce coma, reduces (glucose) metabolism to decrease continued damage to the brain surgical interventions include burr holes (to evacuate hematoma or remove blood clot), craniotomy (relieves pressure of brain tumor), and a brain flap may be removed (to allow room for the brain to expand). post-op care is important, especially relating to IICP and respiratory function. For Head Injuries: tetanus immunization status should be checked and updated, especially when lacerations or contaminated wounds are present. Anticonvulsants may be needed to control or provide prophylaxis for seizure activity. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for minor pain control. Beta-blockers can be prescribed for patients with trauma-induced migraines.
hypotension is a indicative of morbidity
STAGE 1: 2-4 years after onset short term memeory loss; forgets locations and names of objects attempts to cover up memory loss has difficulty learning new information or making decisions decreased attention span can be angry or depressed antidementia meds are trying to prolong this stage. STAGE 2: 2-10 years after end of stage 1 unable to remember names of family members and gets lost in familiar locations easily agitated and irritable has difficulty using objects; reading, writing, and speaking cannot follow a conversation personal hygiene declines unable to make decisions (choose clothing) walks and unsteady gait, head down, shoulders bent, shuffles exhibits "sundowning" and wandering behavior STAGE 3: 1-3 years after stage 2 cannot recognize self or others inability to communicate has delusions and hallucinations
bowel and bladder incontinence
unexpected
Flaccid paralysis Hypo-reflexia
- 12 to 18 year olds - starts w/ myoclonic jerks
- rx = lifelong valproic acid (lots of potential side effects)
CSF examination: look for elevated gamma globulin MRI: look for demyelinating plaques Evoked Potential Testing: the presence of demyelinating lesions on sensory pathways can be confirmed by visual, auditory, or somatosenory evoked potentials.
CT Scan: for areas of different densities
Purpose: To reduce unnecessary utilization of hospital resources, to give the most efficient care possible (because time is of the essence). Clinical pathways are multidisciplinary plans (or blueprint for a plan of care) of best clinical practice for specified groups of patients with a particular diagnosis that aid in the coordination and delivery of high quality care.
focuses on immobility, altered nutrition, impaired communication and self-care deficits.
-infx -stress
-post-partum (relapse less common during pregnancy)
photocoagulation (laser beam destroy's new vessels and seals leaking vessels)
Alert; oriented to person, time, place; understands verbal and written words
Contraindicated for pregnant women Destroys thyroid Fast the night before Benefits may not be seen for 4-6 weeks Avoid contact with other ppl for 2-4 days Increase fluid intake to flush body Expect tenderness in neck
Wash clothes, oral care, bathing separately.
pneumonia/resp conditions septicemia- skin, urine, lungs heart disease(cardiomyopathy of immobility)
Subsequent trauma (often suicide)
5
The most common type of Glioma. Earliest S&S: headache. Also, seizures, memory loss, weakness, visual symptoms, personality changes.
-Having to urinate too often in small amounts -Problems emptying all the urine from the bladder
-Loss of bladder control
• weight gain • peripheral edema
clouding of the lens
Fight or flight response
brief, repetitive episodes of sudden severe facial pain. pain is experienced on surface of skin. begins one side of mouth, rises towards ear, eye, or nose on same side of face. can have remissions. less likely to as you age, dull ache present between attacks.
Weber test
glasgow's coma scale, A&O x3, widening pulse pressure, abnormal body posturing, cushing's triad, cranial nerve checks, confusion, hallucinations, out of control emotions diagnostic tests for head injuries blood glucose, ABGs, tox screen, creatinine, BUN, liver function tests, CBC + diff, CT, MRI, LP, cerebral angiography, xray of the brain will be able to determine where the injury is, how big it is with an LP, encourage fluid intake - CSF reproduces after 24h hours when an LP is done, there is a space in the spinal column. pat may complain of HA because the air from that space naturally goes upwards, in this case towards the head.
to test to see if leakage is CSF, check for glucose - see halo on gauze.
removal by centesis of fluid from the subarachnoid space of the lumbar region of the spinal cord for diagnostic or therapeutic purposes
Regular
The result of certain right parietal lobe lesions that leave a patient completely inattentive to stimuli to her left, including the left side of her own body.
This is a disorder that involves a sudden episode of abnormal, uncontrolled dis- charge of the electrical activity of the neurons within the brain. The patient may experience a variety of symptoms depending on the type of seizure and the cause.
Optic Nerve - sensory
photocoagulation or cryosurgery
An inflammation of the meninges caused by a viral pathogen Incidence and type of pathogen are highly dependent on geographic locale; Tends to be less acute
Occur most in the anterior lobe; Classed by type of hormone secreted; subclassified as functioning, hormone secreting, or nonfunctioning; Tx med or surg; excellent prognosis
Full: alert, oriented to time place, and person, pt fully understands written and spoken words. Confusion: unable to think rapidly and clearly; easily bewildered (confused) with short attention span and poor memory. Disorientation: disorientened to time, place, and person. Obtundation: appears drowsy and lethargic; responds to verbal and tactile stimuli but quickly drifts back to sleep. Stupor: generally unresponsive; may withdraw purposefully with vigorous or painful stimuli.
Coma: unarousable, does not stir or moan in response to stimuli
Acoustic or Vestibulocochlear
Complication of Hypothyroidism Resp depression, reduced cardiac output, and cerebral hypoxia Life-threatening
immediately call the primary care provider while elevating the head of the bed and administering oxygen. the client is likely experiencing a potentially fatal complication of pulmonary embolism. all efforts must be made to facilitate the client's respiratory process.
near sighted
Flashes of light, Floaters, NO PAIN!!!, sclera buckling
Glaucoma is a chronic disease. it is not curable and its consequences are irreversible. therefor, the nurse should help the client realize the importance of lifelong compliance with glaucoma medication therapy.
Assess ability to swallow, chew, and taste Assess weight daily Assess bowel sounds Assess/monitor changes in vital signs Assess respiratory rate, character, and use of accessory muscle Administer oxygen as ordered Administer medications as ordered
-Involvement of different parts of the CNS at different times -MRI demonstrating multiple lesions -Must be multifocal (2 foci) -must relapse and remit (2 episodes) -Dx probable in patients with one lesion and two episodes or two lesions and one episode -in pts with single clinical episode who don't meet radiographic criteria, a dx of "clinically isolated syndrome" is made -these pts are at risk of developing MS and are given beta-interferon
-Repeat MRI 6-12 months later looking for new lesions
Assess, suggest adaptive devices, teach intervetions r/t altered bowel/bladder function
-Less commonly patients will have steadily progressive symptoms from the outset -Disability develops at a relatively early stage
Moderately severe cognitive decline; moderate or mid-stage AD; increasing cognitive deficits emerge; inability to recall important details such as address, telephone number or schools attended, but memory of information about self & family remains intact; disorientation & confusion as to time & place
-CSF sample withdrawn from spinal canal
common benign encapsulated tumors of arachnoid cells on the meninges; slow growing & occur most often in middle-aged adults (often women); oten in areas proximal to venous sinuses; symptomatic lesions are completely removed w/surgery or partial dissection; 15% of brain tumors
Decorticate posture: an abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest. This type of posturing is a sign of severe damage in the brain Decerebrate posture: an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly. This type of posturing usually means there has been severe damage to the brain.
Flaccid response: quality of lack of tone of muscular or vascular organ or tissue.
70-110
classic triad (tremors, rigidity, kinesia) bradykinesia akinisea dyskenesia stupor mask like face, poor blink reflex, wide open eye unsteady on feet shuffling gait cognitive impairment drooling loss of postural control slowed, monotonous speech
dysphagia
action that makes a problem or a disease (or its symptoms) worse
Normal function; no memory problems
Monitor neuro status for changes, monitor respiratory status for changes, encourage self-care, allow patient extra time, encourage exercise; assist with passive ROM if necessary, weigh patient; I&O; explain importance of following med schedule as well as effects of medication wearing off; reduce falls at home.
The middle-aged adult family member may become the care-taker for an older parent. An older adult may be unable to care for a spouse who has had a stroke. They may have to accept placement of the spouse into an LTC.
Emphasize that physical function may continue to improve for up to 3 months, and speech may continue to improve even longer.
unexpected
1) MVA 2) Falls 3)Violence
4) Sports
assess the client's circulation in the operative leg as compared with the nonoperative leg.
The priority of care during the initial period is preserving functional brain cells and preventing acute complications. Once the client's condition is stable, problems of physical mobility, communication, sensory-perceptual deficits, bowel and urine eliminations, and swallowing present the major nursing challenges.
When the affected brain cells can no longer perform their normal inhibitory function within the CNS
Auditory receptive areas, plays a role in memory of sound and understanding language and music.
Midbrain, pons, and medulla
While transient ischemic attack (TIA) is often labeled "mini-stroke," it is more accurately characterized as a "warning stroke," a warning you should take very seriously.
TIA is caused by a clot; the only difference between a stroke and TIA is that with TIA the blockage is transient (temporary). TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. Unlike a stroke, when a TIA is over, there's no permanent injury to the brain.
osmotic diuretics (Mannitol) expel large amount of h2o and electrolytes - may have to switch to loop diuretic. Corticosteroids reduce inflammation. Zantac, Protonix, or antacids are given to prevent GI irritation. Antemetics are used to prevent vomiting. Anticonvulsants (Dilantin, Valium, phenobarbital). Barbituates are given to induce coma, last resort, reduces metabolism and slows brain death.
Nursing Implications:
Assess, provide skin care, active ROM exercises, maintain pos Nitrogen balance & hydration. Monitor for infection
stress, fever, overexertion, and exposure to heat. relieved by rest.
exaggerated subjective response to a painful stimuli, w/ a continuing sensation of pain after the stimulation has ceased.
Very severe cognitive decline; severe or late-stage AD; ability to respond to environment, speak, & control movement is lost; unrecognizable speech; general urinary incontinence; inability to eat w/out assistance & impaired swallowing; gradual loss of all ability to move extremities (ataxia)
Best response for each: -Eye (4 points max) -Verbal (5 points max)
-Motor (6 points max)
..., These injuries to the cerebrum occur when a blow to the head caused the brain to shift towards the area of impact and injure itself by hitting the inner surface of the skull, and then rebounding in the opposite direction and injuring itself again by hitting the skull on the opposite side of the skull where the original blow was delivered.
condition resulting from decreased sensory input or input that is monotonous, unpatterned, or meaningless.
posterior area of the eye where it is attached
inner ear defects
Parkinson's Disease: chronic progressive degenerative neurologic disease that alters motor coordination. Myasthenia Gravis: chronic autoimmune disorder. MS: chronic degenerative disease that damages the myelin sheath aurrounding the axons of the CNS Huntington's disease: progressive neurologic disease.
Stimulator placed in the body below clavicle and lead connected to vagus nerve --> provides intermittent stimulation --> battery lasts 6 to 10 years Effectiveness / Outcome -30-50% of patients with reduction in seizure frequency -4-10% seizure free
-About equal to AED efficacy, but no systemic side-effects
Talk about changing modifiers to prevent future TIAs or CVAs: controlling hypertension (stress, meds), reinforcing the benefits of anticoagulant therapy and other info about medications, low-cholesterol and low-fat diet to reduce arteriosclerosis, etc. when to seek medical care; complications such as aspiration, pneumonia, UTI, skin breakdown; safety measures to prevent falls; psychologic support.
Approved for: -Focal Side effects:
-Weight gain, edema, somnolence, dizziness, ataxia, tremor
thrombolytic drugs dissolve blood clots that have already formed within the walls of a blood vessel. is prescribed after an ischemic stroke has occurred, within 3 hours of onset this therapy is given. 0.9mg/kg, 10% given IV bolus over one minute, the rest given over 60 minutes. criteria for receiving thrombolytic drugs: • Age 18 years or older • Clinical diagnosis of ischemic stroke • Time of onset of stroke known and is 3 hours or less • Systolic blood pressure <185 mm Hg; diastolic <110 mm Hg • Not a minor stroke or rapidly resolving stroke • No seizure at onset of stroke • Not taking warfarin (Coumadin) • Prothrombin time <15 seconds or INR <1.7 • Not receiving heparin during the past 48 hours with elevated partial thromboplastin time • Platelet count >100,000/mm3 • No prior intracranial hemorrhage, neoplasm, arteriovenous malformation, or aneurysm • No major surgical procedures within 14 days • No stroke, serious head injury, or intracranial surgery within 3 months • No gastrointestinal or urinary bleeding within 21 days assess q 15min for first hour, then every 15-30 minutes for the next 8 hours, then at least q4hrs. bleeding and IICP are side effects to monitor for. draw CBC before starting thrombolytics patients is critical and cared for in ICU for 48 hours
used as soon as possible after formulation of clot
weakness, atrophy, fasciculations, loss of reflex in arm>>legs -sensory loss of "cape" Loss of pain and temp
SPARING of vibration and proprioception
-13-15 minor head trauma -9-12 moderate head trauma
assess the client's level of functioning and arrange for a sign interpreter as needed.
L1-2
May be caused prenatally by the mother contracting rubella or other infection, malnutrition, abnormal attachment of the placenta, toxemia, radiation, or medication. Perinatally, it may be caused by a difficult birth, prolapsed umbilical cord, or multiple births.
Postnatally, an infant might develop it as a result of trauma and result in prolonged anorexia or decreased circulation to the brain.
Internal form of radiation; Surgical implantation of radioactive capsules directly into tumor bed; May be temporary or permanent; Generally reserved for high-grade gliomas
-occurs after injury at thoracic level --> decrease in sympathetic out flow = "all brake, no gas" = all parasympathetic, no sympathetic
-often looks like the patient is bleeding out (hypovolemic shock)
results in total loss of sensory and motor function below the level of the lesion(injury),
Muscle and abd cramps, positive chvostek's and trousseau's sign
LOC: EARLY IICP: restleness, irritability, LATE IICP: coma, no response to stimuli Pupils: EARLY IICP: equal round and reactive to light. LATE IICP: sluggish response, progressing to fixed response, pupils may dilate only on one side. Vision: EARLY IICP: decreased visual acuity, blurred vision. LATE IICP: unable to assess Motor Function: EARLY IICP: weakness in on extremity or side. LATE IICP: decorticate or decebrate posturing. Speech: EARLY IICP: difficulty speaking. LATE IICP: cannot assess due to decrease in LOC. Blood Pressure: EARLY IICP: elevated blood pressure. LATE IICP: Cushing's Triad, increased systolic BP, wideining pulse pressure, bradycardia Pulse: EARLY IICP: slighty elevated. LATE IICP: widening pulse. Respiration: EARLY IICP: rate may increase. LATE IICP: decreased respiratory rate or cheyne-stokes breathing. Temperature: EARLY IICP: may be decreased or increased. LATE IICP: significantly elevated.
Other sx: EARLY IICP: headaches worse on rising in the morning and with position changes, LATE IICP: Continual headache, projectile vomitiing. Loss of pupil, corneal, gag, and swallowing reflexes.
Correct Answer: B Rationale: The patient with a T1 injury can expect to retain full motor and sensory function of the arms. Use of only the shoulders is associated with cervical spine injury. Total loss of respiratory function occurs with injuries above the C4 level and is permanent. Bradycardia is associated with injuries above the T6 level.
...
slow progression / atrophy
Blurred vision, decreased color perception: early; diplopia, reduced visual acuity, absence of red reflex; pain and eye redness are associated w late forms
Purely an upper motor neuron deficit in the limbs -the tract involved is the Lateral Corticospinal Tract
Meningitis: inflammation of the meninges of the brain and spinal cord. Enchephalitis: an acute inflammation of the white and gray matter of the brain.
Brain abscess: collection of purulent material within the brain.
restlessness, fidgety, minor gait changes, freq falls, postural differences, protruding tongue, Slurred speech, decreased ability for ADL's, irritability, rage followed by euphoria, depression, suicide
Pediatric population, or elderly -Peds: occurs b/c of the elasticity in the bony pediatric spine
-Elderly: often in cervical spine d/t hyperextension, and the presence of spondylosis
Initiate seizure precautions, place a trach set at the bedside, administer ca gluconate, VS, monitor for tetany
pallor on elevation of limbs and rubor when limbs are dependent.
Frequent episodes of ostitis media or otosclerosis
Shrugging the shoulders against resistance
...
2 or + exacerbation separated by 1 mo and lasts +24 hrs. OR history of repeated exacerbation & remissions w/ or w/o recovery followed by increase in symptoms for 6 or + months. OR
slow increase in symptoms for 6 months
- Simple partial or complex partial szs w/ focus in TEMPORAL lobe then bilateral, often among those w/ history of febrile seizures
Rx = may respond to meds, may need surgery
- antibiotics, IV steroid, universal precautions usually enough unless person has meningococcal which is spread by droplet (put in isolation at first until culture is back)
elevate hob 30-45 degrees, maintain eye patch, orient to environment, side rails, assist w ambulation
causing dilation or constriction of the blood vessels
2. Explain the sounds in the environment; Moving the client is not wise, as he and his roommate obviously need to be watched closely. Telling them to ignore the noise or playing music to cover it is not as helpful as explaining the sounds in the environment. When clients understand the meaning of the sounds, the stimuli are frequently less confusing and more easily ignored.
This is a complication of a fracture, especially of the long bone, that can occur in the first 48-72 h after theinjury.
most children w/ difficult seizures - increases ketones and acids in the bloodstream
chronic metabolic disease characterized in which bone loss causes decreased density and increased fracture risk
...
Cataracts
severe/rapid weakness, loss of muscle strength, progresses to quadriplegia & resp failure. decrease in DTRs, paresthesias, numbness, pain esp at night, facial muscle involvement. Involvement of Autonomic nervous=bradycardia, sweating, fluctuating BP. LAST 2 WEEKs
progressive, degenerative, inherited neurological disease= progressive dementia, and jerky, rapid involuntary movements. Onset is in 30's.
paralysis, muscle mass decrease, progressive fatigue, atrophy of tongue & facial muscles= dysphagia/dysarthria. Emotional libility & loss of control. eventually patient will need total care and ventilatory support.
-temporary loss of all ascending and descending communication past the injured segment -transient loss of reflex activity
Lasting for hours to days or weeks
...
-cross sectional images; contrast optional -know if pt has allergy to shellfish or iodine: these allergies require different contrast media
inability to chew and swallow, decreased ability to move tongue, impairment of fine motor movements= inability to eat. complications: weight loss, dehydration, skin breakdown, aspiration,
Spinal shock: 50% = dec reflexes; flaccid paralysis below level of injury; lasts 24-72 hours to months; not usual in lumbar injury; difficult to make predictions. Return of spinal reflex signals end of spinal shock= paralysis replaced by reflex of spasticity & Autonomic dysreflexia (LIFE THREATENING) Autonomic dysreflexia - severe HTN, bradycardia, severe headache, diaphoresis above injury, nasal congestion, piloerection, nausea, blurred vision, anxiety, impending doom. Caused by distended bladder/rectum or any sensory stimulation. Nsg. Elevate HOB 45 degrees or sit pt up & Call Dr; assess B/P, cause-bladder, catheter, give antiHTNM, procarida, Nitro paste. Teach how to prevent, S/S, what to do Rehab-focus on pt goals/needs, pt expected to participate/learn self-care,
Planning: Maintain opt. neuro function; minimal/no complications; learn skills, self-care, return home and function optimally
a sense of physical tiredness and lack of energy distinct from sadness or weakness Fatigue interferes with physical functioning
Correct Answer: C Rationale: Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient's respiratory function. The other actions are also appropriate but are not as important as assessment of respiratory effort.
Interferon Beta-1B
results from increased production of ACTH -form of obesity w/redistribution of fat to facial, supraclavicular, & abd areas -hypertension -purple striae & ecchymoses -osteoporosis -elevated blood glucose levels
-emotional disorders
3. Assess factors that mainly cause hearing impairments in baby; Women who are considering pregnancy should be advised of the importance of testing for syphilis and rubella, which can cause hearing impairments in newborns.
Motor
results in miced loss of voluntary motor activiey and senstion and leaves some tracts intact.
affects anterior horn cells of spinal cord, motor nuclei of brain stem, and upper motor neurons of cerebral cortex. Cells die= axonal degeneration, demyelination, glial proliferation and scarring along corticospinal tract. Cells try to grow new attachments to muscle, but that eventually fails.
Can be aroused by extreme or repeated stimuli
Persistent focal motor seizure activity (i.e. focal motor status epilepticus) -Distal hand and foot muscles are most often affected
-Active or passive movement of limb may exacerbate activity
Correct Answer: D Rationale: Maintenance of sexuality is an important aspect of rehabilitation after spinal cord injury and should be handled by someone with expertise in sexual counseling. Although the patient should discuss these issues with his wife, open communication about this issue may be difficult without the assistance of a counselor. Sildenafil does assist with erectile dysfunction after spinal cord injury, but the patient's sexuality is not determined solely by the ability to have an erection. Reflex erections are common after upper motor neuron injury, but these erections are uncontrolled and cannot be maintained during coitus.
Correct Answer: D Rationale: Clinical manifestations of spinal shock include decreased reflexes, loss of sensation, and flaccid paralysis below the area of injury. Hypotension, bradycardia, and warm extremities are evidence of neurogenic shock. Involuntary spastic movements and hyperactive reflexes are not seen in the patient at this stage of spinal cord injury.
-Intraventricular catheter (ventriculostomy) -Subacrachnoid screw or bolt
-Epidural or subdural sensor
Wet and Dry
drops to the center of the eye; then apply ointment
Abducens - motor: muscles that move the eye
a visual display of brain activity that detects where a radioactive form of glucose goes while the brain performs a given task
loss of motor function below level of lesion Loss of pain and temp below level of lesion loss of bladder & bowel control
-PRESERVATION of vibration and proprioception
Use of meds, washing hands, not touching eyes
stress
lens removal
Diploplia (double vision), decreased vision at night, photosensitivity
Meniere's Disease
cont to produce antibodies . Possible source of autoantigen that triggers MG
an isolated area of diminished vision within the visual field
Clear away all rugs from the home, make environment clutter free, and use electric shaver.
expected
double vision, occurs when the mm that control the eyes are not well coordinated
Nursing care focuses on assisting the client and caregiver to maintain the highest quality of life. Diags: Disturbed Thought Process, Self-Care Deficits, Caregiver Role Strain
-"extensor posturing"; -abduction of arms, elbow and wrist extension
dominant autosomal trait causes localized death of neurons in basal ganglia. If parent has it, each kid has 50% chance of having it only need 1 gene for disease expression.
the nurse should adminster PPI because they are at high risk for Gi erosion and bleeding. from the steriod. Answer: B
-chemo -external-beam radiation therapy -brachytherapy (surgical implantation of radiation sources to deliver high doses at a short distance) -IV autologous bone marrow transplantation (helps pt from bone marrow toxicity assoc w/high doses of chemo & radiation - fraction of pts bone marrow is aspirated usually from iliac crest & stored; reinfused after tx is completed)
-Gene transfer therapy (uses retroviral vectors to carry genes to the tumor, reprogramming tumor tissu for susceptibility to tx)
2. Uses a wheelchair due to paraplegia. Because of the paraplegia (paralysis of lower body), the client is unable to feel discomfort. The client will be taught to lift self using chair arms every 10 minutes if possible.
metastasize outside of CNS
X-rays CT Scans MRI Cerebral angiography: contrast material is injected and an combined X-ray and fluroscopy is performed. Myelography: X-ray of spinal cord and canal after contrast media is injected. PET: radioactive agent is injected and CT measures metabolic activity of the brain. Ultrasound Carotid duplex study: sound waves identify blood flow velocity to determine the presence of occlusive vascular disease. EEG EMG: needles inserted in muscles to record electrical activity.
Evoked potentials: electrodes are placed on scalp and skin to record the visual or auditory stimulus along sensory pathways
...
...
Muscle rigidity Pin rolling Bradykinesia Stooped posture, and shuffling gait
Difficulty swallowing
Associated with low TH levels Angina, heart failure, dysrhythmia, infarction, etc.
Begin drug therapy in low doses and monitor for rapid HR, palpitations, and chest pain early in therapy.
a study that uses sound for detection of blood flow within the vessels; used to assess intermittent claudication, deep vein thrombosis, and other blood flow abnormalities
a problem with coordination between the bladder contraction and sphincter relaxation: results in urgency, increase in urinary frequency, hesitancy in initiating urine flow, nocturia, dribbling and incontinence
Cornea transplant
identification of a familiar smell with eyes closed.
C5 & T12
Originate in another part of the body and travel to the brain Most common sites of primary disease are lung, breast, and skin; Spread mostly arterially and also via the meninges
Tunning fork to the top of the head
involves the conscious organization and translation of the data or stimuli into meaningful information
-numbness, weakness, tingling or unsteadiness in a limb -Spastic paraparesis -Retrobulbar optic neuritis -Diplopia -Dysequilibrium -Sphincter diturbance (urinary urgency or hesitancy)
*Symptoms may disappear after a few days or weeks, but on exam there may be residual deficit
X-linked bulbospinal neuronopathy that has a more benign prognosis
Houses the reflex arc for actions such as the knee-jerk reflex
Extreme drowsiness but will respond to stimuli
the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system
an abnormal condition of elevated pressure within an eye, obstruction of the outflow of aqueaous humor
I&O, q2hr offer bedpan or urinal, maintain skin integrity in the perineal area, promote daily intake of 2L, but limit intake at night, high-fiber diet, offer the bedpan/urinal at the same times each day, stool softeners as ordered, increase physical mobility as tolerated (increases peristalsis)
-aspiration precautions (check for gag reflex, ability to swallow) -teach pt w/decreased gag response to direct food/fluids toward unaffected side, sit upright, semisoft diet, & have suction readily available -neuro checks -VS -space interventions to prevent rapid increase in ICP -reorient pt to person, time, place -monitor for seizures & protect from injury -motor/sensory function
-eye movement & pupillary size & reaction
-mesencephalon, pons and medulla oblongata (extend from the base of the brain to the foramen magnum)
1. Werdnig-Hoffman dz 2. late childhood 3. Kugelberg-Welander syndrome
4. adult onset
About 50% of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as spinal shock. Central cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. Anterior cord syndrome results in motor and sensory loss but not reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. Points Earned: 1.0/1.0
Correct Answer(s): B
...
2. Mental status; Mental status is assessed while performing a history. Kinesthetic perception, deep tendon reflexes, and cranial nerves are assessed during the physical exam, not the history.
• Absence (formerly called "petit mal"): staring for a few seconds and unresponsive • Myoclonic: quick jerks • Clonic: rhythmic jerking (eg. dorsiflex the ankle and it jerks) • Tonic: stiffening (sustained posture) • Tonic-clonic: stiffening → jerking (start tonic eg. pt w/ seizures in the hospitalist shadowing)
• Atonic: brief loss of muscle tone
weakening of intercostal muscles. decrease in diaphra movement, dyspnea, poor gas exchange complications: decreased ability to walk, eat and ADL's, pneumonia
Brain disorder characterized by enduring predisposition to generate seizures + actual occurrence of at least one seizure
Ischemic Stroke Modifiers: • Hypertension (Because HBP damages arteries throughout the body, it is critical to keep your blood pressure within acceptable ranges to protect your brain from this often disabling or fatal event.) • Atrial fibrillation • Hyperlipidemia • Diabetes mellitus (associated with accelerated atherogenesis) • Smoking • Asymptomatic carotid stenosis • Obesity • Excessive alcohol consumption Hemorrhagic Stroke Modifiers:
Primary prevention of hemorrhagic stroke is the best ap- proach and includes managing hypertension and ameliorat- ing other significant risk factors. Control of hypertension, especially in people older than 55 years of age, reduces the risk of hemorrhagic stroke. Additional risk factors are increased age, male gender, and excessive alcohol intake. Stroke risk screenings provide an ideal opportunity to lower hemorrhagic stroke risk by identifying high- risk individuals or groups and educating patients and the community about recognition and prevention.
damage to Broca's area can cause this condition in which person cannot talk, though understand speech
the most common general symptoms: Impulsive behavior Loss of memory Impaired perception Personality changes Loss of taste and smell Diminished concentration Hearing and balance disorders Cognitive fatigue Concussion Coma Epilepsy open head injury: open wound on head, no nerves receptors so patient might not even realize the extent of injuries. Most open head injuries expose the brain to the outside environment, leaving victims extremely susceptible to infection (meningitis). closed head injury: Loss of consciousness Dilated pupils Respiratory issues Convulsions Headache Dizziness Nausea and vomiting Cerebrospinal fluid leaking from nose or ears Speech and language problems Vision issues scalp injury: concussion: immediate loss of consciousness for <5min. drowsiness, confusion, dizziness, HA, blurred or double vision. contusion: varies with the size and location of injury. initial loss of consciousness;if LOC remmains altered, client may become combative. During unconsciousness, lies motionless; has pale, clammy skin; faint pulse; hypotension; shallow resps; altered motor responses. epidural hematoma: brief loss of consciousness followed by a short period of alterntess. the client rapidly progresses into coma with decorticate or decerebate posturing, ipsilateral pupil dilation, and seizures. subdural hematoma: acute - rapid deterioration from drowsiness and confusion to coma, ipsilateral pupil dilation and contralateral hemiparesis subacute - appear 48 hours - 2 weeks later; alert period followed by slow progression to coma chronic - develops within weeks/months after initial injury. slowed thinking, confusion, drowsiness; may progress to pupil changes and motor deficits
intracerebral hematoma: decreased LOC; pupil changes and motor deficits.
Intention tremors, Vary from mild to massive involuntary movements Tremors can impose significant limitations in activity
Radiation therapy that delivers single high dose of radiation; First preferred treatment or follow-up; Two types: Gamma knife radiosurgery, Cyber knife radiosurgery
-acromegaly (enlarged hands/feet, distortion of facial features, pressure on peripheral nerves - entrapment syndromes)
Oral meds, insulin, diet, exercise
No. The CT results indicate that it has been several hours since the infarction occurred thrombolytic therapy should be given within 3 hrs of the onset of symptoms.
- 4 to 8 y/o - staring off for a few sec then back to "normal"; can elicit this via hyperventilation during P/E - AEDs - best is ethosusimide then valproic acid
- 2/3 recover from this and stop rx
a chronic progressive nervous disorder involving loss of myelin sheath around certain nerve fibers. Onset 15-50 yrs old
malignant or congenital
1, 3, & 4. Identify yourself by name, stay in the client's field of vision, and explain the sounds in the environment.
Options 2 and 5 relate to interventions for a client with a hearing impairment.
Lower motor neuron deficit in the limbs due to degeneration of the anterior horn cells in the spinal cord
•Myelopathy develops in some infected pts after an initial latency period of several years •MRI, CSF, EP findings may mimic MS •Differentiated from MS by the presence of HTLV-1 antibodies in blood and CSF •Treatment with oral corticosteroids may be helpful
•Prevention of transmission
...
History and physical; MRI of suspected region; Pathologic examination - get a piece and send off to lab
Manifests between ages 2-8 yrs, triad of: 1. Mental retardation 2. Diffuse slow spike and wave pattern on EEG 3. Multiple types of generalized seizures
problem in which a perosn lacks bladder control d/t brain or nerve condition
Correct Answer: A Rationale: Because the patient's bladder is spastic and will empty in response to overstretching of the bladder wall, the most appropriate method is to avoid incontinence by emptying the bladder at regular intervals through intermittent catheterization. Assisting the patient to the toilet will not be helpful because the bladder will not empty. The Credé method is more appropriate for a bladder that is flaccid, such as occurs with a reflexic neurogenic bladder. Catheterization after voiding will not resolve the patient's incontinence.
Sudden interruption of activity associated with unresponsiveness and blank stare, sometimes with eyelid fluttering -Often precipitated by hyperventilation
Teach patient/parent about: Dizziness, nausea vomiting, when to call HCP Visual disturbances; blurring, pupils Headaches LOC - Keep patient oriented, check pt at least every hour
Avoiding contact sports
injury to throacic, lumbar, or sacral spinal cord --> loss of lower extremities
42% of all brain tumors are this type. 77% of malignant tumors are this type.
diminished accommodation, increased IOP
- motor - sensory eg visual hallucinations; burnt rubber smell - autonomic - emotional/psychic - fear, deja vue
1. Obtaining an amplified telephone; The amplified telephone helps with hearing and provides a means for communicating with others.
Option 2 refers to a tactile impairment. Option 3 relates to a visual impairment, and option 4 an olfactory impairment.
3. Establishing a routine identified with each meal; Regular meaningful stimuli will benefit the client. The radio can provide meaningful or meaningless stimuli. The nurse must carefully choose programming based on the client's preferences and expose the client to that programming only at appropriate times. Listening to the radio constantly can introduce meaningless stimuli that confuse the client. A 24-hour light may actually keep clients awake, leading to sleep deprivation. Safety is a priority diagnosis but is not an intervention to provide environmental stimuli.
helps if given during first 2 weeks of onset. Removes antibiodies and given immunosuppressive meds at same time.
bulbar, cervical, thoracic, lumbosacral
Eating Devices • Nonskid mats to stabilize plates • Plate guards to prevent food from being pushed off plate • Wide-grip utensils to accommodate a weak grasp Bathing and Grooming Devices • Long-handled bath sponge • Grab bars, nonskid mats, handheld shower heads • Electric razors with head at 90 degrees to handle • Shower and tub seats, stationary or on wheels Toileting Aids • Raised toilet seat • Grab bars next to toilet Dressing Aids • Velcro closures • Elastic shoelaces • Long-handled shoe horn Mobility Aids • Canes, walkers, wheelchairs
• Transfer devices such as transfer boards and belts
Joint pain & stiffness Pain with ROM Crepitus Herberden's nodes
Inflammation
the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system
3. Disturbed sensory perception; The transfer to a different setting can change the amount or pattern of incoming stimuli, and the client may have a diminished, exaggerated, distorted, or impaired response to such stimuli.
Disturbed Thought Processes is applied when cognitive abilities (e.g., dementia) interfere with the ability to interpret stimuli accurately. Options 1 & 2 offer no evidence to support chronic confusion or impaired memory.
Yes, medical Emergency!! 20% mortality.
...
Disturbed sensory perception Risk for Injury Social Isolation
Self-care deficit
Partial, generalized seizure
Broad spectrum AED that is also good for h/a but has s/e related to weight gain, tremors, alopecia
Blidness or defective vision in half of the visual field in one or both eyes, usually due to stroke, brain tumor, or trauma.
-In some MS patients, the clinical course changes from relapsing-remitting to a steady deterioration, unrelated to acute relapses
ACTH, Prednisone, Methylprednisolone. Used to sustain remission and treat exacerbation. used to suppress immune system.
direct sun; no bending or straining, coughing, sneezing, or blowing the nose
unequal curve in the cornea
Sensory
physical therapy will demonstrate assistive devices, social services can arrange referral to home health agency, transfer to rehab center, or job retraining program.
Asymmetric mm weakness, cramping, and atrophy in the hands, Mm fasciculations due to mm weakness, Mm weakness will continue throughout the body distal to proximal
Muscular Dystrophy Association (MDA) Outpatient Therapy
Support Groups
spastic (most common): the cortex is affected resulting in the child having a scissor-like gait where one foot crosses in front of the other foot. other s&s: underdeveloped limbs, increased deep tendon reflexes, contractures, involuntary muscle contraction and relaxation, flexion. athetoid: the basal ganglia are affected resulting in uncoordinated involuntary motion. other s&s: uncontrolled involuntary movements, drooling writhing, all extremities move with voluntary movement, difficulty swallowing, facial grimacing.
ataxic: the cerebellum is affected resulting in poor balance and difficulty with muscle coordination. other s&s: wide-based gait, unsteadiness, clumsiness, poor balance, unnatural muscle coordination.
preventions: allow the client time to grieve or to express denial, depression, and anger over the changes in social, financial, and personal roles - the patient needs time to adjust to lifestyle changes. provide accurate information based on the physician's prognosis. include family and significant others to treat the client as normally as possible. refer the client and family to support groups.
-episodic neurologic symptoms -under age 55 at onset -single pathologic lesion cannot explain the clinical findings
-Multiple inflammatory foci best visualized on MRI
Astrocytomas Oligodendromas
Ependymomas
continuous neurological deterioration from onset of S&S
knowledge & judgment. all are compounds of a mental status examination. assessment of knowledge and judgment are included in cognitive processes.
no s/sx during early stages, TUNNEL VISION,halos around lights, inability to detect color
4. Sensory overload; Sensoristasis is time of optimum arousal, not too much or too little. Sensory reception is the process of receiving internal and external data. This is partially correct, in that the client does receive data that may result in behavior changes. However, Answer 4 is a better answer in that it more directly addresses the situation presented. Stereognosis is the awareness of an object's size, shape, and texture.
d. Elevated blood glucose level and low plasma bicarbonate level
Over 60 Postmenopausal women Family History Thin body build Low calcium and Vit D Smoker
Immobile
Usually benign; Most common: ___ of the acoustic nerve(also called acoustic neuromas) Untreated lesions can become large (compress the facial or trigeminal nerves)
supplement counseling, but doesn't replace.
-at least partial recovery from acute exacerbations -relapses -no means of preventing progression
-1/2 of pts are w/o significant disability even 10 yrs after onset of symptoms
balance and equalibrium
Correct Answer: D Rationale: The best action by the nurse will be to involve all the parties in developing an optimal plan of care. Because family members who will be assisting with the patient's ongoing care need to feel that their input is important, telling the family that the patient can perform ADLs independently is not the best choice. Reminding the patient about the importance of independence may not change the behaviors of the family members. Supporting the activities of the spouse and parents will lead to ongoing dependency by the patient.
have tendency to be overweight due to immobility & depression. Goal to stay at normal weight. Adjust for disphagia,
1. "Water?"; A simple, clearly spoken, one-word question is less confusing and easier to understand than more complex phrases. Simple is more easily heard than complex. The more words there are in a sentence, the more likely it is that some will not be understood, causing a distortion in meaning.
Difficulty initiating movement
-CT (#, size, density of lesions & cerebral edema) -MRI (most helpful in detecting tumors) -PET (supplements MRI) -Cerebral angiography (visualize cerebral blood vessels)
-EEG (detects abnormal brain waves in tumor region)
Varies by diagnosis; Added to the treatment regimen for many reasons, including: Slow tumor growth, Stabilize the tumor, Prevent recurrence, Increase QOL/survival
Concentration, abstract thought, information storage/memory, motor function, speech motor function, affect, judgement, personality, inhibitions.
no discharge in not when palpating the lacrimal apparatus. PERRLA are intact bilaterally. Irises are brown bilaterally. Corneas are clear bilaterally. Visual acuity in right, left, and both eyes together is 20/20 with correction.
Cross eyes
Dopamine deficiency occurs in basil ganglia. the dopamine releasing pathway that connects the substantia nigra to the corpus stratum
=rigid (extensor) response =abnormal flexion (spastic) response =withdraws from pain =purposeful movements from pain
=obeys commands for movement
injury to spinal cord in the cervial region --> loss of muscle strength in all 4 extremities
Most common causes: stroke, meningitis, encephalitis, hypoxic-ischemic encephalopathy 1. Ensure ABCs 2. Get labs and start normal saline 3. IV lorazepam, then phenytoin/fosphenytoin
4. If seizures persist -> additional IV fosphenytoin -> IV midazolam -> IV phenobarbital -> induce barbiturate coma
Hypotension Digestive/Bowel/Bladder activity slows or stops
aphasia
...
Sudden, rapid flexion of neck and truck, adduction of shoulders and outstretched arms, variable flexion of lower extremities -Tx: vigabatrin
based on S&S, history of recent infection, elevated CSF protein, EMG studies show decreased nerve conduction.
make schedule of the client's daily activities, label drawers containing client's clothes and label rooms, use communication techniques to the client's level of ability, when the client is agitated re-direct attention, if pt wanders they need a MedicAlert, schedule rest periods or quite times throughout the day, set boundaries by placing red or yellow tape on the floor, assign the same caregivers as much as possible, music/art therapy, orient to person place and time if needed.
condition resulting from excessive sensory input to which the brain is unable to meaningfully respond
MRI= lesions seen CT= atrophy & white matter lesions CFS analysis= increase of T lymphocytes w/ antigens
Also increase in IgG
autoimmune, lacrimal gland dysfunction, Vitamin A deficiency, post menapausal
Tensilon test. Edrophomium chloride (ashort acting anticholinesterase) if symptoms abate for 5 mins, w/ improved muscle strength, then myasthenic crisis. NO imporvement= cholinergic.
given to relasping/remitting. Prolongs onset of disability.
BP elevation, bradycardia, sweating, piloerection, headache
"do you have difficulty remembering things?" memory is test during the mental status exam, which evaluates cerebral function. numbness and tingling are abnormal findings of the sensory system. balance is a test for muscle function, and the sense of taste is controlled by cranial nerves VII and IX.
Add fiber to the diet Rest periods Skin moisturizers Low cal diet Increase fluid intake
Cough & deep breathe
-continuous monitoring of intracranial pressure by an invasive transducer -rarely used; usually for comatose pts; GCS <8
-Nursing Priority: prevent infections from occuring.
Medication that crosses blood brain barrier. Goes into the brain and converts to dopamine.
combo of anything
2. Place liquid deodorant on a gauze near the clean, covered wound; The odor from a draining wound can be minimized by keeping the dressing dry and clean and applying a liquid deodorant on a gauze near the wound.
weakness, fatigue, decreased function, comlplications; decrease ability to preform ADL's, immobility, myasthenic and cholinergic crisis
bone marrow depression, increase risk of cancer. Hepatitis W/ Imuran. Cytoxan SE= hemorrhagic cystitis, sterility, stomatitis.
supportive, manage ICP, dexamethasone to decrease cerebral edema; antivirals. Dilantin; meds for pain/fever; monitor for cues, seizure precautions, neural assessment
Acute phase: Aggressive respiratory therapy. Above C5 injury are intubated/ventilator. Intermittent positive-pressure breathing (IPPB) are used to prevent atelectasis. Foley catheter, surgery/immobilization, tracheotomy if long-term ventilation is needed. Parentreal nutrition and fluids until the GI tract starts functioning. A diet high in protein and fiber. Bowel program during spinal shock: manual disipaction and small-volume enemas. PT and OT therapy: passive ROM and then aggressive rehab long term. Chronic phase: orthostatic hypotension prevention, dietary management (weight gain likely), skin care/turning, respiratory management.
convulsion characterized by alternating contractions and relaxations
left hemisphere lesion: right hemiplegia, right visual field deficits, aphasia both expressive and receptive, agrahia - difficulty writing, alexia - reading problems, aware of deficits, impaired intellectual ability, no memory deficits, no hearing deficits, deficits in the right visual field as reading, problems and inability to discriminate words and letters, behavior slow cautious and disorganized, anxious when attempting new task, depression, sense of guilt, quick anger and frustration, feeling of worthlessness, worries over the future
right hemisphere lesion: left hemiplegia, left visual deficits, disoriented to time place and person, cannot recognize faces, spatial - perception deficits, neglect of left side, patient unaware of paralyzed side, loss of depth perception, impulsive - easily distracted, unaware of neurological deficits, confabulates, euphoric impaired sense of humor, constantly smiles, denies illness, poor judgement, overestimates ability, loss of ability to hear tonal variations
• slow to load (especially in patients already taking valproate) • expensive • not good drug if need to get pt on seizure med ASAP (but can introduce later)
May induce bad rash
Generalized seizure disorder of infants -Recurrent spasms, EEG pattern of hypsarrhythmia, retardation -Associated with tuberous sclerosis
-Tx: ACTH
Age
based on which muscle group involved
Growth and spread similar to astro; Can spread to CSF pathways (rarely spread outside of brain or spinal cord) S/S vary by size and location. Surgical resection and radiation; Has a little better prognosis than Astro
chronic autoimmune neuromuscular disorder characterized by fatigue, weakness of skeletal muscle.
Nonrhythmic, rapid, jerking movements that can be local or widespread -Some patients may exhibit diffuse, severe nonepileptic myoclonus after anoxic brain injury
-Tx: valproic acid (DOC)
measure, record, and compare right and left calf and thigh circumferences.
based on S&S and test results for other disorders were negative.
syndrome of massive imbalanced reflex of sympathetic discharge occurring in SCI at T5-T6 (above visceral sympathetic outflow)
Nuchal rigidity: neck stiffness Photophobia: intolerance of bright light Opisthotnus: A type of spasm in which the head and heels arch backward in extreme hyperextension and the body forms a reverse bow Kerning's sign: is positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful
Brudzinski's sign: is the appearance of involuntary lifting of the legs when lifting a patient's head.
which is the feeling of pins and needles or numbness of the face, body and extremities.
Stretching, Topical cold, Rotational movement to decrease tone
Cholinesterase inhibitor drugs, such as Cognex (40-80mh 4x/day, admin 1hr before or 2hr after meal), Aricept (5-10mg/day bedtime), and Exelon (1.5-6mg b.i.d), Reminyl (4-12mg b.i.d), and Namada (5-10mg b.i.d) block the breakdown of acetylcholine. Slows cognitive decline. Monitor ALT levels with cognex, elevated levels may indicate hepatoxicty Adverse Reactions: N/V/D, HA, confusion, upset stomach.
SSRIs such as Prozac treat depression. Risperdal or Seroquel is used to control behavioral symptoms.
1) first seizure, unprovoked: - ID cause (labs eg. CBC, electrolytes, UA, toxicity screen, BUN, Glu). Cause found, then treat it - No cause ID --> no AED (b/c 50% will go on to have seizures, but 50% will not) - F/u tests (MRI, etc - missed anything/) - NO DRIVING 2) second seizure - AED (b/c most likely to continue having seizures)
- which AED?
Approved for: -Absence Side effects:
-Nausea, sedation, BM suppression, rash
sound heard equally in both ears. the weber test is examining for lateralization. if the sounds is heard equally in both ears, it is considered a negative test.
Interferon Beta-1A
Acute pain, altered nutrition.
tearing, vision changes, edema, Very PAINFUL!
20/200 vision or less even with correction.
is a form of medical imaging that visualizes the arterial and venous supply of the brain. It was pioneered by Dr Egas Moniz in 1927, and is now the gold standard for detecting vascular problems of the brain.
Nonfluent aphasia w/ impaired comprehension. Both Broca's and Wernicke's areas affected.
Mild cognitive decline; problems w/memory or concentration may be measurable in clinical testing or during a detailed medical interview; mild cognitive deficit, including losing or misplacing important objects; decreased ability to plan; short-term memory loss noticeable to close relatives; decreased attention span; difficulty remembering words or names; difficulty in social or work situations
Spinal cord injury with out radiologic abnormality
vascular compression and demeylination of nerve caused by trauma, infection of jaw/teeth, aneurysm, tumor, MS.
...
Focal seizure in which consciousness IS impaired -Common feature: motionless stare during which patient does not respond to external stimuli and expresses automatisms
-Patient does not remember seizure
peace
No, elevated protien and lymphocytes, IgG are not specific to MS.
angioma
destruction of myelin sheath (plaques) around axons in nervous cells, disrupting/ distorting the conduction of electrical impulses. Only nerves in CNS affected, no peripheral nerves. Early= inflammation/edema around plaques. Later in disease= scarring of glia and degeneration of axon
herpes which causes coneal scaring (stress can cause a herpes breakout)
Located in the cerebrum, the brainstem, and the cerebellum Named for cell types from which they arise
Glioma refers to intra-axial tumor and there are 3 types
cornea inflammation
a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body.
• broad spectrum • seems to be very potent
• less sedating than other AEDs
2. A deaf 88-year-old single client with +4 edema who lives in an upstairs apartment; Sensory stimulation comes from our senses, environment, and presence of meaningful data. Although the client has no sight and is unable to get out of bed, she is still capable and likely to receive sensory stimulation. She may converse with staff and other residents, feel the touch of bathing, and taste a variety of foods. There is a potential for sensory deprivation related to abandonment and the presence of anomalies. Since the child is being cared for in a special needs foster home, and attends preschool, one can reasonably assume that the child receives some stimulation. Premature infants in Neonatal Intensive Care Units often suffer from sensory overload.
paralysis isn't permanent, rationals for interventions to increase compliance
akinesia (inability to initiate movement) and akathisia (inability to remain motionless), dystonia. relating to the part of the nervous system that affects body posture and promotes smooth and uninterrupted movement of various muscle groups.
Correct Answer: B Rationale: The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is causing the symptoms, including hypertension. Notification of the patient's health care provider is appropriate after the BP is obtained. Administration of an antiemetic is indicated after autonomic dysreflexia is ruled out as the cause of the nausea. The nurse may assess for a fecal impaction, but this should be done after checking the BP and lidocaine jelly should be used to prevent further increases in the BP.
encourage the client to turn her head to scan the lost visual field. approach the client from the unimpaired field of vision. place objects in the client's unimpaired field of vision.
a slight or partial paralysis. Use Light resistance training to treat.
freq infections r/t inability to cough, move secretions, breath deeply
jerky eye movements during the six cardinal fields of gaze test. Nystagmus is demonstrated with jerky eye movements during the six cardinal fields of gaze test. Strabisms is demonstrated by one eye gazing in a different direction than the other eye. Ptosis is demonstrated by droopy eyelids that partially or completely cover the pupil. nicking of the retinal blood vessels indicates damage to the blood vessels of the eye.
• Face the patient and establish eye contact. • Speak in a normal manner and tone. • Use short phrases, "yes" and "no" questions, and pause between phrases to allow the patient time to understand what is being said. • Limit conversation to practical and concrete matters. • Use gestures, pictures, objects, and writing. • As the patient uses and handles an object, say what the object is. It helps to match the words with the object or action. • Be consistent in using the same words and gestures each time you give instructions or ask a question. • Keep extraneous noises and sounds to a minimum. Too much background noise can distract the patient or make it difficult to sort out the message being spoken.
• Ask them to nod the head or blink their eyes, provide pad and pencil, magic slate, flash cards, computerized talking board, and/or pictures boards to help with communication.
Contraindicated: hemorrhagic diseases, TB, leukemia, uncontrolled HTN, GI ulcers, recent surgery of eye or CNS, aneurysm. Use during pregnancy can cause fetal death. May be contraindicated with a hypersensitivity to pork products.
aphasia characterized by fluent but meaningless speech and severe impairment of the ability to understand spoken or written words
plasmapheresis
1. Identifying taste c. Visual 2. Stereognosis e. Tactile 3. Snellen chart b. Gustatory 4. Identifying aromas d. Olfactory
•Bilateral involvement of motor cranial nerves •Similar presentation to Progressive Bulbar Palsy in terms of symptoms •Exam: tongue is spastic and contracted, cannot move quickly from side to side •Upper motor neuron dysfunction
•"Pseudobulbar affect" - uncontrollable and inappropriate laughing or crying
finger to the nose
an immunosuppressive drug (trade name Imuran) used to prevent rejection of a transplanted organ
most common type of intracerebral brain neoplasm; spread by infiltrating into surrounding neural connective tissue & therefore cannot be totally removed w/o causing considerable damage to vital structures
Electromyography - To detect fasciculations Muscle biopsy - To rule out muscle disease Spinal tap - Reveals a higher protein level
motor impairment without sensory impairment*
expected
Anti platelet drugs prevent thrombus formation in the arterial system (as opposed to anticoagulants, that prevent thrombosis in the venous system). they work by decreasing the platelet's ability to stick together in the blood, thus forming a clot. Often prescribed prophylactically to pts with a-fib for risk of embolic strokes, but have no other warning signs or indicators of future stroke.
Compared with antiplatelet therapy, oral anticoagulation significantly reduces stroke at an average follow-up of one to three years, but does not reduce mortality. Applied to all-comers with atrial fibrillation, aspirin reduces stroke by 20 percent, whereas warfarin (Coumadin) reduces it by 65 percent. But SEVERE Intracranial or extracranial hemorrhage is more common with anticoagulation and must be weighed against its therapeutic benefit.
•Characterized by optic neuritis and acute myelitis with MRI changes that involve at least three segments of the spinal cord (brain MRI usually does not show white matter involvement but if present it does not rule out this dx) •Isolated myelitis or optic neuritis may occur •Specific antibody marker (NMO-IgG)
•Treatment is long-term immunosupression
Few S/E and no DDIs so good drug esp not sure the type of seizure; drug of choice although can cause behavioral problems (affect, etc)
-assesses electrical activity of brain noninvasively; detection of seizures, behavioural changes, sleep disorders; electrodes placed on head -review meds to be taken by pt with provider -shampoo hair--no gels, oils, sprays
-pt to be sleep deprived if possible to increase intracranial stress
...
atherosclerosis of large cerebral arteries (thrombotic) a-fib, CHF, endocarditis, rheumatic heart disease, mitral valve disease (embolic) HTN (hemorrhagic) risk factors: male, over 65 years of age, african american, hypertension, DM, obesity, a-fib, atherosclerosis, smoking, high cholesterol diet, excessive use of alcohol, cocaine/heroin, oral contraceptives.
Another common cause of intracerebral hemorrhage in the elderly is cerebral amyloid angiopathy, which involves damage caused by the deposit of beta-amyloid protein in the small and medium-sized blood vessels of the brain
severely altered gait, uncontrolled movements, facial grimacing, dysphagia, unintelligible speech, impaired diaphragm, immobility, aspirations, poor O2 sats, cachexia, loss of memory and cognitive skills, total dependence of care
Injury to spinal cord interrupting nerve impulses btwn PNS & CNS impairing sensory & motor function Spinal Nerves: Cervical 8; Thoracic 12; Lumbar 5
rapidly progressive, degenerative neurological disease defined by weakness, wasting of voluntary muscles w/o sensory changes. Fatal
wax build up
the adjustment of the body temp to the room temperature occurs because of the interruption of the sns prevenets peripheal temp sensationf from reaching the hypothalamus
Polyuria, Polydipsia, Polyphagia
Major sensory and motor pathway for impulses running to and from the cerebrum. Regulates body functions (resp, auditory, visual, gag, swallowing, coughing)
Aura = subjective; at onset of seizure but w/o clinical signs of seizure
Automatism = coordinated, stereotyped, involuntary motor activity (lip smacking, hand wringing, verbalization of short, stereotyped phrases)
First clinical and EEG changes indicate initial activation of a system of neurons limited to one part of one cerebral hemisphere -Tx: carbamazepine, phenytoin, oxcarbazepine, topiramate, valproic acid
impaired ability to carry out motor activities despite intact motor function
-Craniotomy (incision into the skull) -decompression (partial removal to relieve symptoms)
-stereotactic approach (involves the use of 3 dimensional frame that allows very precise localization of tumor) with a linear accelerator of gamma knife to perform radiosurgery; allows tx of deep, inaccessible tumors, often in single session
•Presents as weakness in the legs and incontinence •Spastic paresis and sensory ataxia are seen on physical exam •Late manifestation •Most pts have associated HIV encephalopathy •Diagnosis of exclusion •LP to ruleout CMV polyneuropathy
•MRI to exclude epidural lymphoma
Neostigmine, ambenonium, Pryridostigmine,. enhances effects of acetylcholine at remaining skeletal muscle sites, increases muscle contractions.
Frequent assesment of vital signs Careful assement of neurological status Maintaining patent airway Maintaing fluid and electrolyte balance Assesing for s/s of bleeding Parental education and support Elevate HOB 30 degrees, keep head still Use logrolling Nutrition ROM - Mobility Avoid vaso Vagus stimulation Monitor lab values
Assess for s/s of infection
-Bladder becomes too full and you may leak urine -Problems starting to urinate or emptying all the urine from the bladder -Unable to tell when the bladder is full
-Urinary retention
risk for injury related to impaired vision. a client with visual deficits is at risk for tripping and falling over unseen obstacles and incurring a serious injury. the client does not report a lack of interactions or sensory overload. the client doe not show any signs of confusion.
may take months to 2 years. generally muscle strength and function return in descending order.
Major motor and sensory pathway. Controls smooth, coordinated muscle mvmts and helps maintain equilibrium
20ft
Bradykinesia: since the extrapyramidal system regulates posture and skeletal muscle tone, a result is the characteristic of bradykinesia of Parkinson's. It is a slowness of movement. Slowness in the execution of movement, not initiation (like akinesia). "Stone face".
Pill Rolling: The Parkinson's tremor tends to more often affect the hands and causes a movement sometimes referred to as "pill rolling". This "pill rolling" 'tremor' involves the uncontrolled movement of the thumb and finger(s) in a back and forth motion. This may also appear as the thumb and fingers are rubbing together, hence the term "pill rolling" movement. These tremors are usually rhythmic and may occur between 4 to 5 cycles per second. It may only affect one side of the body, or one hand, but as the disease progresses, the tremor may become more generalized affecting many parts of the body.
Medication that activate release of dopamine. Work in conjunction with dopaminergics for better results. Monitor orthostatic hypertension, dyskinesia, and hallucinations.
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
Falls, UTI,Incontinence, Anxiety, Contractures, Skin Breakdown, Depression
the client will have motor effects of the left side; therefore, objects should be placed on the unaffected right side within the client's reach.
" I will sleep with a heating pad on my feet at night to increase the circulation and warmth in my feet." Never apply direct heat to the extremity as sensitivity is decreased and the client may inadvertently be burned. the client should be instructed to walk until point of pain, stop and rest, and then walk a little farther. the client should change positions frequently, avoid crossing legs, and refrain from wearing restrictive garments. sitting with legs in the dependent position for long periods of time lead swelling, which implies circulation.
Slowness of movement
biopsy = chanes of denervation atrophy CSF= normal
CK= slightly elevated, but not as high as in muscular dystrophies
Multiple Sclerosis (MS) starts in ages 20-50 usually, in females more than males. It is due to a demylization of the myelin sheaths of neuron cells in the CNS. Symptoms include extreme fatigue, dizziness, muscle twitching/spasms, numbness, tingling, loss of concentration, sensory and/or visual and/or speech impairment., depression. Myasthenia Gravis starts in ages 20-30 usually, and in females more than males. Autoantibodies from the thymus gland directed at acetylcholine receptor sites impair transmission of impulses across the myoneural junction. This reduces the number of receptor sites. The difference (from MS) is that M. Gravis does not affect the CNS, but instad the nerve-muscle communication point of the PNS. Symptoms include at first diplopia (double vision) and ptosis (dooping of eyelids), and often are accompanied by facial muscle weakness, speech and swallowing impairment, and generalized weakness of the muscles. It is purely a motor disorder and has no effect on sensation or coordination Amyotrophic Lateral Sclerosis (ALS) is a fatal disease of known cause. Death usually occurs as a result of infection, respiratory failure, or aspiration with an avg. time from onset of 3 years. There is a loss of motor neurons in the brain and spinal cord, which decreases function of all smooth and skeletal muscles. The muscles eventually atrophy.
Symptoms depend on the location of the affected motor neurons, because spefic neurons activate specific muscle fibers Chief complaints are fatigue, progressive muscle weakness, craps, fasciculations (twitching), and incoordination.
Signs of meningitis 1. Hips lift head causes them to flex knees and hips
2. flex hip to 90 degrees and straighten it and causes pain
...
moving the tongue up, down, and side to side.
Exaggerated unopposed autonomic response to noxious stimuli for individuals with SCI at or above T6 (as low as T8). Nursing Interventions: bowel/skin care regimen, flushing catheter daily, monitor for distention, I&O, monitor VS for indicators of AD such as hypertension, pounding HA, bradycardia, blurred vision, nausea, nasal congestion, flushing and sweating above the level of injury. If AD is suspected, raise head 90 degrees to lower BP. Monitor BP q3-5min during hypertensive episode. Assess for the cause, implement measures for removing the noxious stimulus. Could be: Bladder distension, bowel constipation/impaction, skin problems (pressure, infection, injury, heat, pain, cold).
Angioplasty In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open. If you have a moderately or severely narrowed neck (carotid) artery, your doctor may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed. Carotid endarterectomy is often not done until several months after a TIA, but a large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because a person is more likely to have a stroke in the first few days and weeks after a TIA.
Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
cells & structures w/i the brain
Low sodium, no caffeine, no alcohol Potassium foods Bedrest Antihistamines, Valium.
Quiet environment, low lighting.
relapses that occur with either full or partial recovery - the periods of relapses are characterized by a lack of disease
progression
Increased intraocular pressure resulting from inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor
Focal seizure in which consciousness is NOT impaired
assess corneal reflex, asses facial nerves ie) blow out cheeks, frown, wink etc. assess oculomotor muscles by following finger with eyes. assess motor portion by pt clenching teeth, apply ice pack, avoid rubbing eye on surgical side,
tachycardia, tachypnea, severe resp distress, dysphagia, restlessness, impaired speech and anxiety.
Corticosteroids: reduces damage and improves functional recovery by protecting the neuromembrane from further destruction. Monitor for increased infection rate, hyperglycemia, GI bleeding. May also use osmotic diuretics, analgesics, antacids, anticoagulants, stool softeners, vasopressors. Histamine H2-receptor antagonists (ranitidine) are used to prevent stress-related gastric ulcers.
Antispasmodics: baclofen, diazepam, dantrolene. they are used to control muscle spasm and pain associated with acute or chronic musculoskeletal conditions. they are not always effective in controlling spasticity resulting from cerebral or spinal cord conditions. assess the client's spasticity and involuntary movements. give with food to decrease GI symptoms. monitor for drowsiness and dizziness.
A state of being unaware of one's surroundings and being unable to react or respond to people, places, or things.
Brain pacemaker. Delivers shocks to the brain and helps stop signals that cause PD
1. Local - stay in that same focus 2. Regional - spreads to other areas of that region (eg from legs to arms in that side of the body)
3. Bilateral (more diffuse spreading) - spreads to both sides of body
Myoclonic jerks of shoulders and arms that usually occur after awakening -Typical age of onset: 12-18 y.o.
-Requires lifelong Tx w/AEDs (esp. levetiracetam)
Acute polyneuropathy, Temporary inflammation and demyelination of the peripheral nerves' myelin sheaths, Results in motor weakness in a distal to proximal fashion with sensory impairment and possible respiratory paralysis. Thought to be an autoimmune response. Recovery is slow and can last 3-12 months.
the inability to switch on and switch off antagonising muscle groups
Progressive loss of joint function characterized by pain
Inner ear infection
Nurses work in diverse community settings to provide primary nursing and health care across the lifespan. Traditionally community nurses meet a continuum-of-health needs that range from the management of specific disease/s to broader community development and public health promotion needs. Health promotion and intervention consciously centre on the client who is viewed holistically; thus, care also considers the social conditions and relationships that affect an individual or a population's health status. In recent years the community nurse's role has begun to shift, directing more attention to the provision of disease recovery nursing care for transitioning clients as they move out of the hospital environment and into the community context. Additionally, the community nurse's role has become more focused on the provision of early intervention measures to prevent exacerbations or complications for clients living with chronic illness/conditions to prevent unnecessary hospital (re)admission.
inflammation or infection of the external canal painful chewing, puritis, edema, watery discharge, crusting are all sx
Vagus
involuntary movements of the eyeballs
up and back: the ear is pulled up and back to straighten the ear canal of an adult and older child, and it is pulled down and back for a child.
...
Hypoglossal -motor: assess tongue control
localized intracranial lesion that occupies space w/i the skull & occurs in any part of brain & classified by cell or tissue of origin; usually grows as a spherical mass, but can grow diffusely & infiltrate tissue
-meningiomas -acoustic neromas, schwannoma
-pituitary adenomas
occurs 2 to 3 weeks after initial onset. symptoms "level off", labile autonomic functions stabilize.
most common cause is vertigo, drugs, food, tobacco and alcohol also some causes sx: sudden vertigo, ataxic gate (loss of cordination) N/V, nystagmus
SEVERE PAIN, N/V erythma of the sclera, enlarged/fixed pupil
retina, optic disc, arteries. the retina, optic disc, and arteries are internal structures of the eye and must be examined with an ophthalmocscope. the cornea, sclera, and iris are all external structures of the eye and can be examined with the nurse's eye.
1. excessive neuronal excitability 2. synapse connections between hypersynchronous neurons - consider contributions of voltage gated ion channels in this process (AEDs act on these ion channels)
- consider balance of GABAergic neurons (inhibitory pathways) and excitatory (esp Glutaminergic) neurons (excitatory pathways)
2. May be accustomed to, and need, high stimulation level; An individual's culture often determines the amount of stimulation that the client considers normal or usual. A person raised in a large active Latino family may be accustomed to more stimulation than an only child raised in a European American family. A decrease in sensory stimulation could result in sensory deprivation or culture shock.
unawareness of deficits (neglect syndrome, overestimation of abilities), impulse-control difficulty, left hemiplegia or hemiparesis, visual changes such as hemianopsia.
About half of patients with partial seizures who don't respond to AEDs are eligible for surgery.
10-21 mm Hg
-T1-weighted lesions show hypointense "black holes" in the brain and cervical spinal cord - Likely areas of axonal damage -hyperintense lesions on non-contrast T1 scans have recently been correlated to disease severity and progression -Gadolinium-enhanced T1-weighted images highlight areas of inflammation with breakdown of BBB (newer lesions)
-T2-weighted images provide information about disease burden and total number of lesions - typically high signal intensity
Approved for: -Infantile spasms Side effects:
-Irreversible visual field constriction, headache, somnolence, dizziness, ataxia, weight gain
Discuss community resources for home health care, meals, equipment, respite care, social services, professional or lay support, and shelters.
Discuss nursing care to promote independence with ADL's.
characteristics of degenerative motor neuron diseases
13. A patient with a neck fracture at the C5 level is admitted to the intensive care unit (ICU) following initial treatment in the emergency room. During initial assessment of the patient, the nurse recognizes the presence of spinal shock on finding a. hypotension, bradycardia, and warm extremities. b. involuntary, spastic movements of the arms and legs. c. the presence of hyperactive reflex activity below the level of the injury.
d. flaccid paralysis and lack of sensation below the level of the injury.
1. Increase dose until no seizures and DON'T stop just because serum drug level is high - "normal" ranges are population averages, not nec individuals 2. If seizures not controlled on maximum tolerated dose, add a 2nd AED 2a. If seizure control achieved: start to taper the first AED 2b. If patient still having seizures: taper one of the two AEDs and start a third 3. If seizures not controlled after trying several AEDs at adequate doses, then a. re-assess diagnosis
b. consider surgical management
8
Acute Considered medical emergency
•Treatment -Physical therapy - exercise of facial muscles -Braces or walker -Portable suction •Feeding tube gastrostomy •Cricopharyngomyotomy •Tracheostomy
•Palliative care
eardrum/ossicles (middle ear) to restore hearing
-loss of hearing -tinnitus -episodes of vertigo -staggering gait
-as tumor sized increases, facial pain on side of tumor due to compression of CN V (trigeminal)
sensorineural. background noise reduces ability to filter and process communication. lateralization to the unaffected side is a sign of sensorineural hearing loss.
1. Disorientation is a normal reaction to sudden blindness; Sudden loss of eyesight can result in disorientation. With gradual loss of sensory function, individuals often develop behaviors to compensate for loss, whereas with sudden loss, the compensatory behavior often takes days or weeks to develop.
Advantages: • easy to load (PO or IV) • once a day dosing • low cost
• in use since 1938 (no surprises)
color blindness
a. in some patients who have gone for a length of time with no seizures, the seizure focus resolves; no test can reliably determine if this has happened, so patients must recognize it is a gamble, but often one worth taking (with physician supervision)
gradual progression of neurological deterioration w/ super-imposes relapses.
caused by overdose of anticholinesterase meds.
Purpose is to destroy tumor cells; Varied methods of administration; Type of drug, dosage, and route of administration are determined by tumor type
Initial monitoring in ICU; Possible need for ICP monitoring; infection, swelling, if tumor is large may need to remove bone flap, frequent neuro checks; avoid things that cause increase in ICP
pain control and risk for impaired skin integrity.
Voluntary control of body movements
use one object as a focal point to orient the client in relations to that point ( to the right of the bes is a closet with two doors, in the 2 o'clock position are green beans.) show the client the way to the bathroom. let the client establish a fixed location for items such as a call bell or phone. don't leave the client alone until the client is familiar with the room. assist the client with ambulation by allowing the client to grasp the guide's arm at the elbow. identify oneself when entering the client's room.
Six cardinal position of gaze
• saturable absorption • short half-life • may be less effective than other AEDs
• expense
Difficulty moving
caucasians more common in men average age onset 60 Age 40-70 Genetics
• no drug interactions • non-hepatic metabolism • easy to load orally • very safe, well tolerated; effective at lower doses than gabapentin
• linear kinetics
2. "I can't hear the doorbell."; This client could use an assistive device that flashes a light when the doorbell rings.
Trochlear - motor: eye movement
Most common cause of intractable complex partial seizures in adults -Due to hippocampal neuron atrophy and gliosis
-Tx: temporal lobectomy
pain d/t increased pressure and usually occurs d/t sudden dilation of the pupil
severe headache, deteriorating LOC, restlessness, irritability, dilated or pinpoint pupils, slow rxn time, altered breathing pattern, deteriorating motor function, abnormal posturing (decorticate, decerebrate, flaccidity)
Age-related Trauma Toxins
Diabetes
floaters, progressive vision loss
Very mild cognitive decline; may be normal age-related changes or very early signs of AD; forgetfulness, especially of everyday objects (eyeglasses or wallet; no memory problems evident to provider, friends, or coworkers
symptomatic therapy
-gliomas (infiltrate portion of brain; most common)
speak to the client at a slower rate. look directly at the client during speech. allow plenty of time for the client to answer. break tasks into parts and give instructions one step at a time. consult a speech and language therapist.
opening and closing of the eyes
19. Assessment findings are flashes of light, floaters, increase in blurred vision, sense of a curtain coming over eye, loss of portion of visual field, painless loss of central or peripheral vision.
ASIA Impairment scale: gauge motor & sensory function CT Scan- gold standard: detects injury, location, level Xrays MRI Myelogram, PFT's
Neuro exam - usually other injuries
pressure dressing, warm or cold compresses, epithelial debridement
Baclofen, Dantrium, Vallium, Zanaflex, Klonopin
-prolactin secreting pituitary adenomas (prolactinomas) -GH secreting pit. adenoma that produce acromegaly in adults -ACTH producing pit. adenomas that result in Cushing's disease
**GH & prolactin adenomas are common
• hepatic enzyme (CP450) inhibitor • drug interactions
Assess, arrange for rest periods, Prioritize activities, avoid temp extremes (hot showers), relieve pain. referrals to groups as needed
apply the stockings in the morning upon awakening and before getting out of bed. apply stockings in the morning upon awakening before getting out of bed to reduce venous stasis and to assist in the venous return of blood to the heart. legs are less edematous at this time. message of affected area may dislodge a clot and cause embolism rolling stockings down may restrict circulation and cause edema.
Trigeminal -mixed - motor: clenching teeth
-sensory: assess ability to taste
Absence seizures that begin in children ages 4-8 y.o. and usually resolve before adulthood
Approved for: -Focal (when converting from another AED) -Generalized tonic-clonic -Lenox-Gastaut Side effects:
-Stevens Johnson syndrome, dizziness, sedation, diplopia, headache, nausea
When a patient is at risk for aspiration, swallow education, dysphagia diet
12
Medications that stimulate release of dopamine and prevent re-uptake. Monitor for signs of swollen ankles and discoloration of the skin.
retinal detachment is a medical emergency and the assistance of a primary care provider should be sought immediately. restrict activity to prevent additional detachment. cover the affected eye with an eye patch. avoid activities that cause rapid eye movement. (reading, writing)
Tumor originate in the ependymal cells lining ventricles found in brain or spinal cord; Can spread along CSF pathways (not into normal brain tissue) obstruct CSF flow->hydrocephalus
CT scan of head, lumbar puncture if pt is stable-should be clear. Cloudy=bacterial; Viral=protein up and glucose normal
Is the term used to describe the state in which a person is in optimal arousal.
block dopamine receptors in brain. Restore balance of neurotransmitters
Visual interpretation and memory.
...
Trauma
Constrict the pupil. Reduce aqueous humor Beta-blockers Prostaglandin-agonist Adrenergic-agonist Cholinergic-agonist
loss of vasomotor caused by injury characerized by hypotension, bradycardia
visual acuity. visual acuity should be assessed first during an eye exam. assessing extraocular movements, internal structures, and visual fields may interfere with the ability of the client to read and demonstrate accurate visual acuity.
Weakness of thoracic muscle is most likely to cause life-threatening complications because affects patients oxygentation and ventilation. Answer is D
=No speech =incomprehensible speech =inappropriate responses, but words make sense =confused conversation, but able to answer questions
tunning fork to the side of the head/ behind the ear
...
• very broad spectrum (good if you don't know what spec type of seizure) • good for migraines
psychological support, respite care, meals on wheels, sources for special adaptive equipment, support groups, social services
Inflammation of the brain tissue: Pronounced -- Severe HA, fever, nausea, vomiting, confusion, change LOC, seizures, cerebral edema, increased ICP, bizarre behavior
Facial -motor: symmetry and mobility of face
-sensory: ability to taste
generalized: -increased ICP (HA, V, visual disturbances) focal: -specific s/s from tumors that interfere w/functions in specific brain regions -hemiparesis -seizures (motor cortex) -mental status changes (frontal) -sensory/motor abnormalities -visual alterations (Occipital) -cognition alterations -language disturbances
-dizziness, staggering gait (cerebellar)
high protein, high calorie, becuase of catatbolism and is necessary for energy and tissue repair
gestures
...
far sighted
Glaucoma
removal of the stapes (in the inner ear)
An inflammation of the meninges caused by a bacterial pathogen; Have photophobia, nuchal rigidity, Brudzinski's and Kernig's sign, HA, temperature, seizures, irritability
provide talking watches and clocks. provide large print books/newspapers/menus. instruct the client to remove area rugs from the home. suggest that the client put important telephone numbers on auto dial.
blurred vision, white pupils, reduced visual acuity. cataracts are generally not painful. floating spots are a characteristic of retinal detachment. red reflexes are generally absent.
extend
Diagnosis - CT, then lumbar puncture (glucose low, protein high, WBC high, opening pressure high)
Occur due to loss of inhibition of mm - Spasticity, clonus, (+) Babinski, Dysarthria, dysphagia, emotional lability. Fatigue, Oral motor impairment, Fasciculations, spasticity, motor paralysis, Respiratory paralysis, Bowel and bladder remain untouched
long term beta-interferon or SQ glatiramer acetate
Azathioprine (Imuran) Cyclophosphamide (Cytoxan)
Medicaid: U.S government sponsored program for low-income individuals and families to pay the cost of health care. Medicaid beneficiaries are low income families and individuals. Covers a wider range than Medicare: hospitalization, x-rays, laboratory services, midwife services, clinic treatment, pediatrics care, family planning, nursing services and in-home nursing facilities for 21+ years, medical and surgical dental care. In some states Medicaid beneficiaries are required to pay the provider a small fee (co-payment) of up to $30 per month for medical services. May require payment of deductibles and co-pay for certain services provided. Program is run by individual states so the type of coverage and policies may vary between states. But generally, patients usually pay no (or very little) part of costs for covered medical expenses. Medicare: U.S government sponsored health care program for people above 65 years of age, people under 65 with certain disabilities and all people with end stage renal disease. Medicare beneficiaries are senior citizens over the age of 65, end stage renal disease, and disabled eligible to receive social security benefits. Divided in to Part A which covers hospital care, Part B which covers medical insurance and Part D covers prescription drugs.
May require payment of deductibles and co-pay for certain services provided., Medicare reserves the right to refuse to pay for treatments it deems unnecessary. Small monthly premiums are required for non-hospital coverage. Federally run so the program and coverage is uniform throughout the country. Run by the Health Care Financing Administration.
Approved for: -Focal -Generalized tonic-clonic -Lennox-Gastaut Side effects:
-Sedation, kidney stones, mental dulling, weight loss
...
•Confusion, ataxia, nystagmus leading to ophthalmoplegia (LR) •+/- Peripheral neuropathy •Due to Thiamine deficiency •Occurs in alcoholics (AIDS, hyperemesis, bariatric surgery) •If suspected, do not delay treatment waiting for confirmatory labs •Thiamine 50mg IV, then IM daily until improvement
Alzheimer's effects cranial nerves, especially #19. patho 1. loss of nerve cells 2. reduce brain size 3. presence of neurofibrillary tangles 4. neuritic plaques by amyloid protein. Aging. One out of eight people over age 65 has Alzheimer's. Nearly half of people over age 85 have the disease. Family history and genetics Another risk factor is family history. Research has shown that those who have a parent, brother or sister with Alzheimer's are two to three times more likely to develop the disease. There appears to be a strong link between serious head injury and future risk of Alzheimer's. It's important to protect your head by buckling your seat belt, wearing your helmet when participating in sports and "fall-proofing" your home. Some evidence suggests that strategies for general healthy aging may also help reduce the risk of developing Alzheimer's. These measures include controlling blood pressure, weight and cholesterol levels; exercising both body and mind; eating a balanced diet; and staying socially active. Scientists don't know yet exactly how Alzheimer's and diabetes are connected, but they do know that excess blood sugar or insulin can harm the brain in several ways: Diabetes raises the risk of heart disease and stroke, which hurt the heart and blood vessels. Damaged blood vessels in the brain may contribute to Alzheimer's disease. The brain depends on many different chemicals, which may be unbalanced by too much insulin. Some of these changes may help trigger Alzheimer's disease.
High blood sugar causes inflammation. This may damage brain cells and help Alzheimer's to develop.
encourage the client to use the unaffected arm, teach family/client to put clothing on the affected extremity first and then dress the unaffected extremity, consult with occupational therapist to teach the client how to use assistive devices for eating, hygiene, and dressing.
Approved for: -Focal Side effects:
-Sedation, ataxia, *weight gain, peripheral edema
GI irritation, skin rash, pruritis, agranulocytosis (report s/s of sore throat or fever) Results achieved in several weeks
inability to coordinate voluntary muscle movements
-intracerebral tumors -tumors arising from supporting structures -developmental tumors
-metastatic tumors
Spastic paralysis Hyper-reflexia
Babinski reflex present
Acute closed angle glaucoma Retinal detachment
3. Explain procedures to client, and talk as if client can hear; The person who is unconscious and unable to respond to the spoken word nevertheless can often hear what is spoken. It is important for nurses to speak in a normal tone of voice and before touching the client. The environmental noise should be kept at a minimum so client can focus on words. Maintain the same schedule every day.
c1-c3 = no movement or sensation below the neck; ventilator-dependent c4 = movement and sensation of head and neck; some partial function of the diaphragm c5= controls head, neck, and shoulders; flexes elbow c6 = uses shoulder, extends wrist c7-c8 = extends elbow, flexes wrist, some use of fingers T1-T5 = has full hand and finger control, full use of thoracic muscles T6-T10 = controls abdominal muscles, has good balance T11-L5 = flexes and abducts the hips; flexes and extends the knee
S1-S5 = full control of legs; progressive bowel, bladder, and sexual function
Olfactory - sensory
ALCOHOL
inability to coordinate voluntary muscle movements
Actions of medication
Continued support and counseling
tumor of CN VIII (vestibulocochlear) most responsible for hearing & balance; may grow slowly & attain considerable size before diagnosed; many are benign; can be removed surgically & have good prognosis
Because the most common cause of autonomic dysreflexia is bladder irritation, immediate catheterization to relieve bladder distention may be necessary. The patient should be positioned upright. Benzodiazepines are contraindicated and suctioning is likely unnecessary. Points Earned: 0.0/1.0
Correct Answer(s): A
•Chronic partial denervation •Abnormal spontaneous activity at rest
•Reduction in the number of muscle units under voluntary control
culture and sensitivity (c/s)
Calcium
initial relapsing-remitting disease course followed by disease progression at varying rates - minor remissions and plateaus may occur during this progression
A child advocacy team or child protective services should be contacted if child abuse is suspected, the mechanism of injury is unknown or unexplained, or the history is inconsistent. NB shock is rarely due to isolated head injury except in young children and in patients with medullary injuries or large scalp lacerations. Pediatric head injury has unique issues that make patient management and outcome different from that of adult head injury. Age related aspects will determine a greater or lesser degree of craniocervical junction injuries (disproportionate cranial size to trunk in infancy and early childhood). Other factors are potential underlying congenital anomalies, physiological factors (cerebrovascular reactivity and blood flow), differing support systems needed from that of adults for neuro imaging and specialized medical, nursing and allied health care support. Pediatric rehabilitation and educational needs and goals are different to that of adult head injury. intubating a child is harder than intubating and adult The physical exam is frequently normal CT scan = significant radiation exposure children sometimes cannot talk but frequently vomit due to stress (instead of head injury) Brain is less myelinated, results in greater sensitivity to shearing forces Cranial bones thinner, resulting in greater transmission of a single force to brain Non-fused sutures makes skull easily deformable Children (particularly < 24 months old) are at increased
risk of cerebral hypo-perfusion after TBI
minimize background noise. write things out that are not understood. allow plenty of time for the client to respond. use brief sentences with simple words. writing things out that are not understood, allowing time for the client to respond, and using simple words and brief sentences will promote communication for the client with aphasia. minimizing background noise will provide a calming environment. the client is not hard of hearing, so speaking loud will not promote communication.
- mossy fibers of hippocampus (key to episodic memory) sprout collateral fibers to facilitate episodic memory so hippo is prone to re-organization of processes being disrupted - seizures themselves may induce collateral sprouting so the more you seize, the more you seize
•Motor conduction is usually normal or slightly reduced •Sensory conduction is normal
Neurogenic shock is due to the loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia. Loss of sympathetic innervation causes peripheral vasodilation, venous pooling, and a decreased cardiac output. Points Earned: 0.0/1.0
Correct Answer(s): A
assess VS/Weight, CBC, platelet count, clotting studies. Check blood type & crossmatch, watchfor hypotension, dizziness. Monitor for infection, electrolyte loss,
Approved for: -Focal -Generalized tonic-clonic Side effects:
-Sedation, dizziness, ataxia, osteopenia, behavior disturbance in children
A patient who has a SCI has neurologic impairment to all extremities and the diaphragm. However, because the injury is C on the ASIA impairment Scale, sensory function can be intact but motor function will be impaired significantly or absent.the patient can lose moderate to complete peristatlic action in the intestines but should reatine the ability to sense bladder fulnessand the position of the legs. Answer is B
-epilepsy & seizures show strong evidence of an association (relationship is unlikely to be causal)
Loosening of clothing around the neck Turn client to side Suction at bedside O2 as ordered Record symptoms during seizure Pad side rails Bed in low position
Fall pads on floor
Snellen chart
removal of the eyeball
ineffective airway clearance, impaired swallowing, PREVENTION of fatigue. keep pt in constant temp. teach to avoid changes in temp.
an abatement in intensity or degree (as in the manifestations of a disease)
Spinal Accessory -motor: patient rotate head and shrug shoulder against resistance
Increase in IOP r/t ocular disease
rhizotomy- surgically severing nerve root. residual pain/numbness from surgery. can lose sensations on affected side of face, lose corneal reflex.
Helping to determine what kind of stroke it is, and acting appropriately. If ischemic, determine if pt is candidate for thrombolytic therapy. If hemorrhagic stroke, measures to reduce bleeding and IICP should be taken. Ischemic: (If non-thrombolytic therapy is needed) Interventions during this period include measures to reduce ICP, such as administering an osmotic diuretic (eg, mannitol), maintaining the partial pres- sure of carbon dioxide (PaCO2) within the range of 30 to 35 mm Hg, and positioning to avoid hypoxia. Other treatment measures include the following: • Elevation of the head of the bed to promote venous drainage and to lower increased ICP • Possible hemicraniectomy for increased ICP from brain edema in a very large stroke • Intubation with an endotracheal tube to establish a patent airway, if necessary • Continuous hemodynamic monitoring (the goals for blood pressure remain controversial for a patient who has not received thrombolytic therapy; antihyperten- sive treatment may be withheld unless the systolic blood pressure exceeds 220 mm Hg or the diastolic blood pressure exceeds 120 mm Hg) • Neurologic assessment to determine if the stroke is evolving and if other acute complications are devel- oping; such complications may include seizures, bleeding from anticoagulation, or medication- induced bradycardia, which can result in hypotension and subsequent decreases in cardiac output and cere- bral perfusion pressure During the acute phase, a neurologic flow sheet is main- tained to provide data about the following important mea- sures of the patient's clinical status: • Change in level of consciousness or responsiveness as evidenced by movement, resistance to changes of po- sition, and response to stimulation; orientation to time, place, and person • Presence or absence of voluntary or involuntary movements of the extremities; muscle tone; body pos- ture; and position of the head • Stiffness or flaccidity of the neck • Eye opening, comparative size of pupils and pupillary reactions to light, and ocular position • Color of the face and extremities; temperature and moisture of the skin • Quality and rates of pulse and respiration; arterial blood gas values as indicated, body temperature, and arterial pressure • Ability to speak • Volume of fluids ingested or administered; volume of urine excreted each 24 hours • Presence of bleeding • Maintenance of blood pressure within the desired pa-
rameters
recommend for pts under 60. taped off steriods. give pyridostigmine given to prevent S&S during surgery. post op care focused on pulmonary hygiene,preventing complications from chest tube & pain control
CROSSED sensory and motor deficit -ipsilateral hemiplegia -ipsilateral loss of vibration, proprioception -CONTRALatera loss of pain & temp
*r/t prssue exerted on optic nerves, optic chiasm, or optic tracts or on the hypothalamus or 3rd ventricle if tumor invades the cavernous sinsuses or expands into sphenoid bone
...
acute inflammatory demyelinating disorder of PNS, characterized by acute motor paralysis accompanied w/ paresthesias/numbness (usually ascending)
Correct Answer: A Rationale: The patient is demonstrating behaviors consistent with the anger phase of the mourning process, and the nurse should allow expression of anger and seek the patient's input into care. Expression of anger is appropriate at this stage and should be tolerated by the nurse. Refusal to acknowledge the patient's anger by telling the patient that the anger is just a phase is inappropriate. Continuing to perform needed assessments and care is appropriate, but the nurse should seek the patient's input into what care is needed.
defects in the function of one or more of the senses, resulting in visual, auditory, or olfactory impairments.
1. Idiopathic vs. symptomatic (of known or suspected CNS pathology) 2. Generalized vs. localization-related (focal) - re. most of the seizures the person experiences
• Result: 4 categories
-look for irritants (bladder, bowel, skin) -empty bladder, bowel, skin, then benzodiazepine, and anti-hypertensives
young adults and individuals in their 50's and 80's, more males than females, more Caucasians than African Americans
•Weakness •No sensory Loss or sphincter disturbance •Progressive course •No identifiable cause other than genetic in familial cases (usually sporadic)
•Onset between age 30 and 60
Anti-platelet drugs. These medications make your platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma.
Anticoagulants. They affect clotting-system proteins instead of platelet function.
Airway & Immobilization Team goals: sustain life; ABC's, prevent further damage NonSx: stabilization of injured segment, decompression of cord, bed rest & immobile, backboard & cervical color, brace/corset for lumbar, Stryker frame, skeletal traction (tongs or halo), cervical traction- pin care, traction, alignment, log rolling, meticulous skin care Sx: cord compression, dec of neuro disorder, fractures, removal of fragments, decompression laminectomy (remove part of vertebral column; spinal fusion; rod insertion (can be anterior, thoracic, posterior approach)
Stimulate patient above level of injury
-corticosteroids can help with recovery from acute relapses -Prednisone 60-80mg daily x3-4wks
-Long-term tx with corticosteroids = no benefit
Focused directly on the tumor; 3D treatments - conformal radiation, Whole-brain radiation generally reserved multiple metastatic lesions
Moderate cognitive decline; mild or early-stage AD; medical interview will detect clear-cut decline; personality changes - appearing withdrawn or subdued, especially in social or mentally challenging situations; obvious memory loss; limited knowledge & memory of recent occasions, current events, or personal history
Strabismus
Full Vital Signs Assess LOC, and orientation, if pt is unconcious use the Glascow Coma Scale Assess strength of hands grip and movement of extremities
Assess pupils using PEERLA
Sensory lobe: person's awareness of body position in space, size and shape discrimination, right-left orientation.
QUIET,CALM ENVIRONMENT, ATB, OTC dramamine, or meclizine, IV fluids if needed for N/V
...
"warfarin takes 3 to 4 days to achieve therapeutic anticoagulant effects, so heparin is continued until the warfarin can take over." Warfarin takes 3 to 4 days to achieve therapeutic anticoagulant effects because it depresses synthesis of clotting factors but does not have any effect on clotting factors that are already present. effects are delayed until the clotting factors that are present decay.
Correct Answer: C, A, B, D Rationale: The first action should be to prevent further injury by stabilizing the patient's spinal cord. Maintenance of oxygenation by administration of 100% O2 is the second priority. Because neurogenic shock is a possible complication, continuous monitoring of heart rhythm and BP is indicated. CT scan to determine the extent and level of injury is needed once initial assessment and stabilization is accomplished.
presbyopia
flush with NS or H2o, ATB drops, if it is a penitrating injury DO NOT REMOVE and cover with a Styrofoam cup
wearing a neck scarf, seasonal allergies, leaning over a side rail, constipation, intestinal flu, tying shoes. ACTIVITIES THAT INCREASE IOP INCLUDE:bending over at the wrist, sneezing, coughing, straining, vomiting, head hyperflexion, restrictive clothing(tight shirt collars)
First clinical and EEG changes indicate initial involvement of both hemispheres -Sustained muscular contraction and rhythmic jerking of muscles -Upward eye deviation, pupillary dilatation, "epileptic cry", may have urinary incontinence -Patient is confused or sleepy afterwards with aching and stiffness
Initial Injury: compression (concussion, contusion); penetrating trauma (laceration, transection); Neuro damage r/t primary injury or secondary damage (ischemia; inflammation; hemorrhage l/t progression of injury 72 hrs to know extent Skeletal level: Cervical = tetraplegia; Thoracic/Lumbar= paraplegia C1-C3 = total loss of respiratory muscle function Below C4 = diaphragmatic breathing, hypoventilation-ventilator at night Above T6 = dec influence of SNS=bradycardia, asystole (dec B/P, dec Pulse); Neurogenic shock= blood not forced to heart l/t dec cardiac output: Peripheral vascular - DVT, pulmonary embolus; orthostatic HTN Degree: Complete cord involvement: total loss of sensory & motor below level of lesion (also loss visceral: GI, Bowel/Bladder, sweat gland control)
Incomplete (partial) cord involvement: Mixed loss of voluntary motor activity & sensation; potential to improve; 6 syndromes
Taking medications at prescribed times Good skin care to avoid skin ulcers Staying physically active (dance, yoga, pilates, biking) Proper ambulation (assistive devices) Proper positioning (avoid ulcers) High-Fiber diet & adequate fluid intake (Prevent constipation)
•Due to vitamin B12 deficiency (pernicious anemia, megaloblastic anemia) •Predominant pyramidal and posterior column deficits plus -Polyneuropathy -Mental changes -Optic neuropathy
•Treatment is with vitamin B12 100mg IM daily x 1 week, weekly for 1 month, then monthly forever
visual disturbances, paresthesias, incontinence, weakness and fatigability
• short half-life • may be less effective than other AEDs
• expense
disease progression occurs from the onset either without remissions or with occasional plateaus and temporary improvement
Spatial-perceptual deficits, increased distractibility, impulsive behavior and poor judgement, lack of awareness of deficits
characterized by periodic remissions and exacerbation of symptoms. Most common
___Lesions of the head and neck can extend directly into the brain; Characteristics vary by primary disease; Presenting sx depend on tumor location
-Monitor labs, monitor VS, monitor for signs of bleeding, reduce risk factors such as shaving (electric), etc. -Patients should be given the NPSA booklet (see guidance and resources) -On discharge, nurses should ensure patients know their drug dosage and arrange follow-up care -There is no evidence to suggest grapefruit juice should be avoided but cranberry juice can affect INR results. Foods rich in vitamin K can affect INR results if eaten in large quantities -Almost any drug can interact with oral anticoagulants, including herbal remedies. Most increase the effect but some reduce it. The INR should be closely monitored when a new drug is started or dose altered
-Patients must know to seek medical attention for injuries, particularly head injuries, due to haemorrhage risk
Aura: bright light Tonic phase: muscles are rigid with the arms extended and jaws clenched Clonic phase: movements are jerky as the muscles alternately contract and relax
Postictal phase: the pt is unconscious for 30 minutes and then regains conciousness slowly
the nurse in most likely to have an anterior cord syndrome resulting in the loss of neuromuscular and pain and temp sensation below t8. Pt will have full use of upper extremities , upper back, and resp muscles.thus she will be in a wheel chair. Best position for her would be C. Hospital case management
4. "It may seem like a train station sometimes, but this is Hogwarts."; Option 4 is the only response that helps orient the client and treats the client with respect.
=Not opening =Opens to pain not applied to face =Opens to verbal commands
=Opens spontaneously
freq UTIs, urinary retention, incontinence, impotence. May have spastic bladder= anticholinergics May have flaccid bladder= cholinergics
