400 Exam 6 Flashcards
1
Q
ϖ Organisms enter the brain in 2 ways
A
o Through the bloodstream from spreading infections
o Direct invasion through a skull fracture or bullet hole
2
Q
example of the bloodstream from spreading infections
A
sinusitis, otitis media, or pneumonia
3
Q
ϖ Patient who are _____ ______ have increased risk for central nervous system infections
A
HIV positive
4
Q
3 major types of central nervous system infections
A
meningitis
encephalitis
brain abcessess
5
Q
ϖ Inflammation of the lining around the brain and spinal cord caused by bacteria, viruses, or fungal infections
A
MENINGITIS
6
Q
♣ Usually self-limiting and does not require extensive treatment
A
viral meningitis
7
Q
treatment of viral meningitis
A
No ATB
only Tx the symptoms
8
Q
viral meningitis can be secondary to?
A
lymphoma
leukemia
HIV
9
Q
most common cause of viral meningitis
A
enterovirus
10
Q
sx of viral meningitis
A
mild flu-like symptoms
11
Q
bacteria in the nasopharynx can enter the blood stream during URI and travel to the CSF and brain
A
o Bacterial (septic meningitis)
12
Q
what increases the risk for bacterial meningitis
A
tobacco use viral upper resp infection otitis media mastoiditis lyme disease
13
Q
bacterial meningitis is a medical _____
A
emergency
14
Q
it is important to manage what with bacterial meningitis
A
fever and headache
15
Q
where will bacterial meningitis patients usually be at?
A
ICU
16
Q
mortality rate with bacterial meningitis is 5-10% within how many hours of diagnosis
A
24-48 hours
17
Q
sx of bacterial meningitis
A
photophobia double vision petechial rash disorientation and memory impairment behavioral manifestations increased ICP N/V Seizures/Coma
18
Q
= extreme light sensitivity (cause is unknown)
A
• Photophobia
19
Q
with purpuric (purple) lesions – striking feature of N. meningitis
A
• Petechial rash
20
Q
where does the petechial rash start?
A
on the trunk then goes to all over body
21
Q
decreased level of consciousness and focal motor deficits
A
• Increased ICP –
22
Q
sx of Increased ICP –
A
drowsiness
sleepiness
hard to arouse
HA
23
Q
Frequently occurs in dense populations (colleges, high schools, military instillations)—any areas where people conjugate (together a lot)
A
ϖ Neisseria meningitidis
24
Q
– classic signs of meningitis
A
o Severe Headache and nuchal rigidity
25
o Viral manifestations much less severe than _____.
bacterial
26
a stiff and painful neck – attempts at flexion of the neck is difficult because of spasms in the muscles in the neck
Nuchal rigidity =
27
_____ tends to remain high throughout illness with meningitis
♣ Fever
28
______ is usually either steady or throbbing and very severe as a result of meningeal irritation
♣ Headache
29
the inability of the patient to extend the leg when the hip is flexed on the abdomen
(+) Kernig’s sign
30
when the patients neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; more sensitive indicator of meningeal irritation than Kernig’s
(+) Brudzinski’s sign
31
diagnostic tests for meningitis
CT/MRI
CSF studies
Spinal Tap
32
♣ CSF studies indicate
low glucose, high protein levels, and high WBC count
33
o Researchers have developed a bedside risk score for unfavorable outcomes (poorer the prognosis)
(What makes meningitis have a poorer prognosis)
```
♣ Older age
♣ Heart rate greater than 120
♣ Low Glasgow coma score
♣ Cranial nerve palsies
♣ Positive gram stain 1 hour after presentation to the hospital
```
34
ϖ Prevention is key for meningitis
meningococcal conjugated vaccine given to high school students and college students
35
o People living in close contact with patients with meningitis should be treated how?
prophylactically usually with some type of antimicrobial chemoprophylaxis.
36
when are people no longer contagious with meningitis
Antibiotics for 24 hours
37
ATB should be given within ___ hours of meningitis
24 hours.
| within 30 min in the hospital
38
what type of isolation with meningitis?
droplet precautions!!
| airborne precautions
39
what type of room with meningitis?
reverse isolation
respiratory isolation room
40
medication for meningitis
Penicillin G
cephalosporins
Dexamethasone
41
which 2 meds are administered together within 30 min of hospital arrival for meningitis patients?
Penicillin G
Cephalosporins
42
decreases inflammation
| steroid due to ICP
dexamethasone
43
when is dexamethasone given for meningitis?
♣ Administered 15-20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days
44
meningitis patients may have hydrocephalus which makes them need a ?
SHUNT
45
what type of precautions for meningitis?
seizure
46
how to prevent seizures?
```
padded side rails
Never force anything in someone’s mouth is clench
Head of bed up
Side lying position
Pad with towels, no pillows!!
```
47
what med to prevent seizure precautions?
phenytoin
48
how often to assess neuro and VS for meningitis?
q 2 hrs
49
what type of environment with meningitis?
private, quiet, dark room
50
ϖ An acute infection of the brain parenchyma (nervous tissue found in the brain) and meninges caused by bacteria, viruses, or fungi
Herpes Simplex Virus encephalitis
51
o Local hemorrhage within the brain that becomes more generalized followed by edema and deterioration of nerve cell bodies
Herpes Simplex Virus encephalitis
52
o Once hemorrhage starts with Herpes Simplex Virus encephalitis, experience edema that leads to???
increased ICP
53
sx of Herpes Simplex Virus encephalitis
```
Fever,
headache,
stiffness in neck (not as severe as meningitis),
increased ICP,
seizures,
decrease LOC,
lethargy,
coma,
dysphagia,
hemiparesis,
skin lesions
```
54
nerve tissue are affected with Herpes Simplex Virus encephalitis that cause?
Residual effect
Cognitive function impairment
personality changes, dementia
can be left deaf or blind
55
how to Dx Herpes Simplex Virus encephalitis
EEG
spinal tap
CSF
56
shows diffuse slowing or focal changes in the temporal lobe
o EEG –
57
how to treat Herpes Simplex Virus encephalitis
```
acyclovir
ganciclovir
morphine/dilaudid
steroids
anticonvulsants
```
58
♣ Early administration improves prognosis
♣ Inhibits viral DNA replication
♣ Prevent relapse continue treatment for up to 3 weeks
♣ Slow IV administration over 1 hour to prevent crystallization of the med in the urine
acyclovir and ganciclovir
59
nursing management for patient with Herpes Simplex Virus encephalitis
assess neuro function q 2 hours
60
o Comfort measures to reduce headache for Herpes Simplex Virus encephalitis
dimming lights, limiting noise and visitors, grouping nursing interventions, administering analgesic meds
61
o why are Opioids are used cautiously in patient with encephalitis –
may mask neuro symptoms
62
o Arthropod-borne virus vectors
| (AKA arbovirus
mosquitoes, ticks, psychodids (type of moth)
63
o Vector borne encephalitis
west Nile
64
(fungal encephalitis is usually with?
AIDs patients
CA
Immunocompromised
65
treatment of fungal encephalitis
antifungals
amphotericin B
fluconazole
66
causes major flu-like symptoms; fever, nausea, vomiting
♣ Amphotericin B—
67
maculopapular skin rash. lymph node enlargement. paralysis
west nile
68
nursing care of encephalitis
```
o Ineffective protection
o Assess LOC continually
o Monitor memory impairment
o Monitor ICP
o Monitor vitalsseptic shock; increased BP and decreased pulse
o Monitor fever
Monitor for seizure activity
o Monitor for cranial nerve damage
o Administer medications as needed
Risk for imbalanced fluid volume
```
69
ϖ Spongiform encephalopathy – degenerative, infectious neuro disorder
\
ϖ Rapidly progressive, degenerative, neurologic disease that causes brain degeneration WITHOUT inflammation
Creutzfeldt – Jakob Disease (CJD
70
CJD has no identifiable cause. however vCJD results from?
ingesting infected meat
71
ϖ Risk of ____ in US in thought to be low because cattle are fed primarily with grass, wheat, and soy-derived feed as opposed to feed containing animal parts
CJD
72
ϖ Clinical manifestations vCJD:
```
behavioral changes,
sensor disturbances,
limb pain,
muscle spasms,
rigidity,
dysarthria,
incoordination,
cognitive symptoms and
sleep disturbances.
```
73
ϖ Clinical manifestations CJD: ]
```
mental deterioration,
ataxia,
visual disturbances,
memory loss,
involuntary movement,
paralysis, and
mute
```
74
diagnosis of CJD or vCJD
EEG
MRI
CSF
75
o reveals a characteristic pattern over duration of the disease
♣ Shows burst-suppressions characterized by periodic spikes alternating with slow periods
EEG
76
treatment of CJD/vCJD
supportive and palliative care
77
o Goals of care with CJD
promotion of comfort measures, prevention of injury related to immobility and dementia, and provision of support and education for family
78
ϖ Prevention of disease transmission is an important part of nursing care of CJD
standard precautions
| DISPOSABLE INSTRUMENTS
79
Why are disposable instruments used for CJD
sterilization methods do not destroy the prion
80
ϖ Autoimmune disorder progressive demyelinating disease of the CNS
Multiple Sclerosis (MS)
81
2 types of MS
relapsing/remitting (RR)
or
Primary Progressive MS
82
o Exacerbations followed by remissions
Can occur over several days or week then get better
relapsing/remitting (RR)
83
o Exacerbations occur but do not normally return to baseline function
o As the nerve fibers become increasingly damaged so does the disabilities for the patient
o Usually in wheel chair
Primary Progressive MS
84
sx of MS
```
fatigue and pain *****
depression
weakness
numbness
difficulty in coordination
loss of balance
eye issues
cognitive and psychomotor changes
bladder, bowel, sexual dysfunction
```
85
may contribute to fatigue with MS
heat, depression, anemia, deconditioning, and meds
86
how to avoid fatigue with MS
avoid heat!!!!!
87
secondary complications with MS
```
UTIs
constipation
pressure ulcers
high risk for falls and injury
malnutrition
conracture deformities
dependent pedal edema
pneumonia
reactive depression
osteoporosis
```
88
o Certain things can exacerbate symptoms of MS:
heat, extreme cold, stress
89
o MRI will show multiple ____ on the brain in the CNS with multiple sclerosis. If plaques do not show up on MRI will do a CSF analysis.
plaques
90
o Electrophoresis of CSF identifies presence of ______ _______ – several bands of immunoglobulin G bonded together, indicating an immune system abnormality
oligoclonal banding
91
collaborative management for MS
keep patient independent
no cure
die of complications (pneumonia)
92
main treatment for MS
interferon beta 1A (Rebif)
interferon beta 1B (Betaseron)
93
• Interferon beta meds can cause major ____-___ symptoms
flu-like
94
flu-like symptoms can be managed with
acetaminophen and ibuprofen and resolve after a few months
95
• Additional side effects of interferon meds for MS
potential liver damage, fetal abnormalities, and depression
96
• Optimal control of disability, interferon meds should be started when with MS?
at the first sign of MS
97
• reduces rate of relapse in the relapsing remitting (RR) MS
Glatiramer acetate
98
* Steroid key agent in treating acute relapse in RR
| * Shortens duration of relapse but no long term effects
♣ IV methylprednisone
99
Medication of choice for spasticity with MS
Baclofen
100
other med to treat spasticity with MS
benzo's
diazepam
tizandinine
dantrolene
101
• Treats fatigue that interferes with ADLs with MS
Amantadine
pemoline
dalfampridine
102
• may be used to treat bladder and bowel problems with MS
♣ Anticholinergics, alpha-adrenergic blockers, anti-spasmodics
103
may be given also to acidify the urine and prevent bacterial growth in MS patients
• Ascorbic acid (vitamin C)
104
assessment with MS
o Assess for weakness, spasticity, visual impairments, bowel and bladder problems
o Assess for impaired speech or swallowing high risk for aspiration
105
ND with MS
```
o Impaired physical mobility
o Risk for injury/fall
o Impaired urinary and bowel elimination
o Impaired verbal communication
o Impaired speech or swallowing
o Risk for aspiration
o Disturbed thought processes as disease progresses
o Ineffective individual coping
o Impaired home maintenance
o Potential for sexual dysfunction
```
106
how to Minimize spasticity and contractures with MS
```
♣ ROM exercise,
physical therapy,
warm packs (not hot bath),
stretching,
balance rest and activity
```
107
how to minimize effects of immobility with MS
Pressure ulcers (Turn q 2),
pressure relieving devices if in wheelchair (egg crate),
coughing and deep breathing (prevent pneumonia).
108
o Preventing injury with MS
walk with wide based gait and stand up straight,
keeping room free of clutter is a priority,
protect the extremities,
double vision (eye-patch)
109
what type of diet with MS
soft diet with thickened liquids
110
o As MS progresses referred to ____ ____. Once it is progressively worsens ____ _____.
home health;
| hospice care
111
ϖ A rare, chronic disease that affects the myoneural junction
ϖ Exact etiology is unknown, thought to be an autoimmune response
Myasthenia Gravis
112
who is more likely to have MG
women
113
ϖ Believed that the ____ ____ plays an active role in the autoimmune response of MG
thymus gland
114
o Antibodies directed at the acetylcholine receptor sites impair transmission of impulses varying degrees of weakness of the voluntary muscles
Myasthenia Gravis
115
sx of MG
```
muscle weakness
generalized fatigue
ptosis
diplopia
bulbar symptoms
hand and arm difficulties
difficulty walking and sitting
bland facial expression
```
116
o Myasthenia gravis is purely a motor disorder with NO effect on _______ or ______.
sensation or coordination
117
weakness of the muscles of the face and throat
o Bulbar symptoms –
118
diagnosis of MG
history and symptoms
Tensilon Test (Edrophonium chloride)
EMG
MRI
119
♣ ______ should be available to control side effects of Tensilon –
Atropine
120
sx of Tensilon
bradycardia, sweating, cramping
121
Tensilon Test (Edrophonium chloride) is contraindicated in patients with _____ patients
cardiac
122
what test is done when Tension test is contraindicated
ice test
123
♣ Ice packs over eyes for 1-2 minutes and symptoms will temporarily resolve
Ice test
124
if droop improves after ice test. result is _____
positive.
125
detects a delay or failure of neuromuscular transmission (looks at muscle fibers)
o EMG
126
the MRI checks for an enlarged ____ ____ with MG
thymus gland
127
plasma exchange technique used to treat exacerbations of MG
o Plasmapheresis –
128
♣ Remove thymus gland since it’s thought that the thymus produces the antibodies
♣ Last resort for patients with severe symptoms
thymectomy
129
o Acute exacerbation of MG is a myasthenic crisis
```
♣ Respiratory infection or distress
♣ Medication change
♣ Medications that can exacerbate MG
♣ Surgery
♣ Pregnancy
♣ Stress and/or trauma
♣ Dysphagia – difficulty swallowing
♣ Dysarthria – difficulty speaking
♣ Eyelid ptosis
♣ Diplopia
♣ Prominent muscle weakness
```
130
myasthenia crisis patients will be where
in ICU for constant monitoring
131
over medicate with cholinesterase inhibitors
toxic response to medication
♣ Profound weakness, copious secretions, and eventually respiratory failure
o Cholinergic crisis
132
should be on hand to treat bradycardia and respiratory distress.
♣ Atropine sulfate
133
if they have MG but not in crisis
treated at home
134
MG in crisis
monitoring accurate neurological and respiratory is essential
135
most common cause of death with MG
respiratory failure
136
what will MG patients get before eating?
Pyridostigmine
137
• Helps to improve swallowing and to eat better to reduce the risk of aspiration
Pyridostigmine
138
ϖ Autoimmune attack on the peripheral nerve myelinacute, rapid segmental demyelination of peripheral nerves and some cranial nerves
Guillain-Barre Syndrome
139
symptoms of GBS
```
ascending weakness with dyskinesia
hyporeflexia
paresthesias
optic nerve demyelination
vagas nerve demyelination
NO loss of LOC
```
140
inability to initiate voluntary movement
♣ Dyskinesia
141
sensation of numbness, tingling, or “pin and needles”
♣ Paresthesias
142
worry about ___ _____ with GBS
respiratory paralysis
143
o Usually some kind of event that occurs about 2 weeks prior to GBS
(flu shot, Epstein-Barr virus, HIV)
144
o Optic nerve demyelination may lead to _____.
blindness
145
o Vegas nerve demyelination leads to?
cardiac issues like bradycardia, tachycardia, hypertension, orthostatic hypotension
146
ϖ May take up to ___ years for full recovery with GBS – some patients may not fully recover
2
147
diagnosis of GBS
history and physical and patients symptoms
148
o Monitoring for life-threatening complications of GBS include:
respiratory failure,
cardiac manifestations,
DVT,
PE
149
GBS patients will be on continuous ____ ______
ECG/telemetry monitoring
150
what should nurse do for paralysis with GBS
PROM
151
ϖ Exact cause unknown
ϖ Involuntary contraction of the facial muscles causing
o Sudden closure of the eye
o Twitching of the mouth
o Usually unilateral
Trigeminal Neuralgia
152
Trigeminal Neuralgia is a condition of the ____ cranial nerve
5th
153
ϖ with Trigeminal Neuralgia Pain is usually related to
a stimulation of the trigeminal of the affected nerve branches
154
what causes pain with Trigeminal Neuralgia
o Touching face/washing face
o Brushing teeth
o Eating
o Drinking food that is too hot/cold
155
nursing management of Trigeminal Neuralgia
prevent pain
| provide post-op care
156
how to prevent pain
```
pain meds
Avoid things that make pain worse
cotton pads and room temp water to wash face
rinse with mouth wash after eating
perform personal hygiene at pain-free intervals
take food and fluids at room temp
chew on unaffected side
ingest soft foods
```
157
Bell’s palsy facial paralysis caused by unilateral inflammation of the ___ cranial nerve
7th
158
o Face become distorted from paralysis
o Decreased lacrimation and painful sensations in the face, behind the ear, and in the eye
o May have difficulties swallowing and eating
o Cause unknown
Bell’s palsy
159
o Goal for Bell's Palsy
maintain muscle tone in face and prevent/minimize denervation
160
ϖ Nursing management of Bell’s palsy
protection of eye from injury while paralysis lasts
161
ϖ Natural barriers of absorption that diminish the efficacy of ocular medications include the following:
o Limited size of the conjunctival sac
o Corneal membrane barriers
o Blood-ocular barriers
o Tearing, blinking, and drainage
162
ϖ _____ solutions are most commonly used for the eye
Aqueous
163
(instilled eye drops and applied ointments) are the most commonly used for ocular disorders
o Topical routes
164
• Major disadvantage of ointments is ____ _____ – can last for a while after application which would be a safety issue
blurred vision
165
o Used before diagnostic procedures or for pts having severe eye pain
ϖ Topical Anesthetic Agents
166
o Anesthesia occurs between ___-___ and can last ___-___ min
with Topical Anesthetic Agents
20 seconds - 1 minute and can last from 10 - 20 minutes
167
o Nurses must educate pts to not ____ _____ – this can cause corneal damage with topical anesthetic agents
rub eyes
168
overuse of Topical Anesthetic Agents can cause
softening of the cornea
169
o Prolonged use of topical anesthetic agents can result in
delayed healing & can lead to permanent corneal opacification and scarring, resulting in visual loss
170
o Usually used in combo for max. pupil dilation
ϖ Mydriatic and Cycloplegic Agents
171
education with Mydriatic and Cycloplegic Agents
temporary glare, inability to focus properly, difficulty reading
172
effects of Mydriatic and Cycloplegic Agents can last?
3 hours to several days
173
advise to wear _____ with Mydriatic and Cycloplegic Agents
sunglassess
174
Mydriatic and Cycloplegia agents affect the CNS and are most prominent in younger and older adults – these pts must be assessed closely for symptoms such as:
* Increased BP
* Tachycardia
* Dizziness
* Ataxia
* Confusion
* Disorientation
* Incoherent speech
* Hallucinations
175
Mydriatic and Cycloplegia agents are Contraindicated in
pts w/ narrow angles or shallow anterior chambers and in pts taking MAOI’s or tricyclic antidepressants
176
Includes antibiotics, antifungals, antivirals
ϖ Anti-Infective Medications –
177
main antifungal med
amphotericin B
178
amphotericin B has serious side effects such as:
Severe pain
Conjunctival necrosis
Inflammation or irritation of the iris (Iritis)
Retinal toxicity
179
o Used for inflame conditions of eye
ϖ Corticosteroids and NSAIDS
180
education with Corticosteroids and NSAIDS
shake the bottle prior to use if it is a suspension
181
o Most common ocular side effect of long term topical corticosteroid administration include:
```
• Glaucoma
• Cataracts
• Susceptibility to infection
• Impaired wound healing
• Mydriasis
• Ptosis
Increase in IOP
```
182
which side effect of topical corticosteroid use is reversible?
increased IOP
183
o Common for a pt with allergies
ϖ Anti-allergy Medications
184
May be used to irrigate the eye or for pts with dry eyes such as artificial tears
ϖ Ocular Irrigants and Lubricants –
185
Nursing Management for Pts Receiving Ocular Medications
ϖ Need to ensure proper administration to maximize the therapeutic effects
186
ϖ To diminish systemic absorption and minimize side effects of ocular medications, it is important to:
o Put gentle pressure on the inner canthus/puncta of the eye for 1 to 2 mins immediately after instilling eye drops
o Wait at least 5 mins before instilling another eye drop, and 10 mins before instilling another ointment into the eye
187
ϖ Second leading cause of blindness in adults in the US
ϖ A group of ocular conditions characterized by ocular nerve damage related to increased intraocular pressure from congestion of aqueous humor in the eye
ϖ Aqueous humor flows between the iris and the lens and nourishes cornea and lens, most of the fluid then flows out through the anterior chamber, drains through trabecular meshwork, when it’s inhibited from flowing out – pressure builds up within the eye
Glaucoma
188
what conditions cause increase IOP--which leads to glaucoma
DM
inflammation of the eye
retinal detachment
189
risk factors for glaucoma
```
FH
Thin cornea
AA
Old Age
DM
Cardiovascular Dx
Migraine syndromes
Myopia
eye trauma
prolonged use of corticosteroids
```
190
nearsightedness
myopia
191
Two Types of Glaucoma
Open-Angle
| Narrowed-Angle
192
o Increase fluid leads to increased IOP, neuronal ischemia and optic nerve degeneration and eventually loss of vision
Open-Angle Glaucoma
193
Open-Angle Glaucoma symptoms
painless
loss of peripheral vision
increased IOP
194
o Obstruction in aqueous humor outflow due to the complete or partial closure of the angle
angle closure (narrowed angle) glaucoma
195
o The obstruction results in an increased IOP, damages the retina neuron and optic nerve which leads to blindness
o Can be an ocular emergency – should be treated immediately
angle closure (narrowed angle) glaucoma
196
sx of angle closure (narrowed angle) glaucoma
```
eye/face pain
malaise
N/V
colored halos around lights
decreased vision
red conjunctiva
corneal cloudiness
```
197
Stages of Glaucoma
1. Initiating Event
2. Structural alterations in the aqueous outflow system
3. Functional alterations
4. Optical nerve damage
5. Visual Loss
198
Must be an initiating event that causes the increased IOP
o Risk factors listed above,
can also include illness, emotional stress, congenital abnormalities, long term use of corticosteroids, and use of mydriatics
1. Initiating event
199
o Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations and may lead to the third stage
not draining properly or no drainage causes pressure to build up
2. Structural alterations in the aqueous outflow system –
200
o Conditions such as increased intraocular pressure or impaired blood flow create functional changes that may lead to the fourth stage
The built up pressure causes functional changes
3. Functional alterations –
201
o Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply
4. Optical nerve damage
202
Progressive loss of vision is characterized by visual field defect – usually starts out with peripheral vision
5. Visual loss –
203
diagnosis of glaucoma
tonometry
funduscopy
fundugonioscopy
visual field testing
204
measures intraocular pressure
ϖ Tonometry –
205
inspection of optic fundus w/ ophthalmoscope
ϖ Funduscopy –
206
measures the depth of the anterior chamber and determines open angle from closed angle glaucoma
ϖ Fundugonioscopy –
207
determines degree of visual field narrowing
ϖ Visual field testing –
208
types of surgeries for glaucoma
```
Trabeculoplasty;
trabeculectomy;
gonioplasty;
laser iridotomy;
peripheral iridectomy
```
209
ND for glaucoma
o Disturbed Sensory Perception: Visual
o Risk for Injury
o Anxiety
210
ϖ Clouding of the lens of the eye that interferes with light transmission
ϖ
Light scatters and does not have sharp vision
ϖ Can develop in one eye or both eyes
CATARACTS
211
sx of Cataracts
```
painless
blurry vision
light scattering
myopic shift
astigmatism
color shift
brunescens
reduced visual acuity
```
212
return of ability to do close work without eyeglasses
ϖ Myopic shift –
213
color values shift to yellow brown
ϖ Brunescens –
214
diagnosis of cataracts
snellen visual acuity test
opthalamoscope
slit-lamp biomicroscopic exam
215
treatment of cataracts
surgery
216
how will they do the cataract surgery
1 eye at a time.
weeks to months in between surgeries
217
ϖ Lens are broken apart and extracted and they will get some type of lens implant
cataract surgery
218
3 replacement options for cataract surgery
o Aphakic eyeglassess
o Contact lenses
o Intraocular lens implants
219
most common replacement option for cataract surgery
intraocular lens implants
220
lens in them to better vision
o Aphakic eyeglasses –
221
ϖ Potential Early Postop Complication with cataracts
o Toxic Anterior Segment Syndrome –
222
Noninfectious inflammation that is a complication of anterior chamber surgery caused by a toxic agent such as agent used to sterilize surgical instruments
o Toxic Anterior Segment Syndrome –
223
o effects of Toxic Anterior Segment Syndrome –
Corneal edema less than 24 hours postop
224
sx of Toxic Anterior Segment Syndrome
o reduced visual acuity and pain
225
treatment of Toxic Anterior Segment Syndrome if theres no growth of MO
topical steroids
226
o Alpha-antagonist, particularly tamsulosin (Flomax), are known to cause a condition called \
intraoperative floppy iris syndrome
227
o Dilating drops are administered prior to surgery
• Every 10 minutes for four doses at least 1 hour before surgery – Additional drops may be administered in the operating room
228
o If an eye patch is worn, it is removed after the first follow up appointment, usually within ___ hours after surgery
48
229
o Vision is stabilized when the eye is completely healed, usually within __-___ weeks, when final corrective prescription is complete
6 to 12
230
o Patients who choose multifocal IOLs should be aware that there may be increased ??????
night glare and contrast sensitivity
231
ϖ Separation of the retina from the sensory layer of eye
| ϖ Can occur spontaneously or from trauma to the eye
RETINAL DETACHMENT
232
allows perception of light
Retina
233
____ _____ can shrink with age and can pull retina from back of eye
ϖ Vitreous humor
234
ϖ Detached retina can increase in ___ and increase in ____ ____
size; vision loss
235
the retina must be restored back in contact w/ eye or _____ can occur which will result in blindness
ischemia
236
sx of retinal detachment
```
ϖ Sudden onset of floaters or spots
ϖ Sensation of curtain coming across the vision of one eye – going black
ϖ Cobwebs
ϖ Bright flashing light
ϖ May have blurred vision
ϖ Painless
```
237
diagnosis of rentinal detachment
dilated fundus examination
stereo fundus photography
fluorescein angiography
optical coherence tomography
238
– creates inflammation and adhesion to weld layers back together
ϖ Cryotherapy or laser photocoagulation
239
causes the fold in sclera to bring the detachment back to contact – contact maintained with a buckle
ϖ Scleral buckling –
240
air bubble is injected and pushes retina into contact with layer of the eye
ϖ Pneumatic retinopexy –
241
ϖ Postop for Pneumatic Retinopexy
o The patient must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break
242
ϖ Education Post Surgery (retinal reattachment)
o Activity restriction, no straining to reduce pressure
| o Wear an eye shield to protect the eye
243
complications of retinal reattachment surgery
increased IOP
| infection
244
ϖ Most common cause of vision loss in people over 60
| pts develop drusen
MACULAR DEGENERATION
245
qdrusen – tiny yellowish spots beneath the retina
drusen –
246
drusen affect vision when located where?
macular area
247
is the area of the retina that provides sharp vision, if this area becomes degenerative, then macular degeneration of vision loss occurs
ϖ Macula
248
with macular degeneration, which vision is most affected
central vision
249
causes of macular degeneration
```
increased age
females
smokers
genetics
long term inflammation of the eye
```
250
2 types of macular degeneration
non-exudative
| exudative
251
o Most common type – between 85%-90% of people have dry type
non-exudative
252
o Drusen outside of the macular area – no symptoms
o Drusen within the macula – gradual blurring of vision that patients may notice when they try to read
o Usually occurs slowly
non-exudative
253
o Formation of new, weak blood vessels between vessel layers and retina
o New blood vessels are weak and prone to leaking, which interferes with vision
o Repeated bleeding will cause scarring
o Straight lines appear crooked and distorted or that letters in words appear broken
o Blurred vision centrally – peripheral vision usually stays intact
exudative
254
dx of macular degeneration
visual and retina exams
| fluorescein angiogram
255
treatment of non-exudative
NO CURE
antioxidants and minerals in megadoses can slow the progression of AMD and vision loss
256
treatment of exudative
laser surgery
| photodynamic therapy meds
257
destroys weak vessels to prevent bleeding
laser surgery
258
will adhere to new blood vessels and stop leaking
o Photodynamic therapy meds
259
after photodynamic therapy treatment for exudative
avoid direct sunlight or bright indoor light for 5 days
260
– grid with straight line—as long as line are straight vision is fine
ϖ Amslers grids
261
ϖ Usually associated with a head injury, which MUST be assessed first!
orbital trauma
262
ϖ Soft tissue orbital injuries often result in damage to the ___ ____.
optic nerve
263
ϖ s/s of orbital trauma from blunt or penetrating trauma include
```
tenderness,
ecchymosis,
lid swelling,
proptosis or exophthalmos, and
hemorrhage
```
264
ϖ Closed injuries lead to contusions w/ subconjunctival hemorrhage, commonly known as a ___ ____.
black eye
265
ϖ Management of soft tissue hemorrhage is usually conservative
o Inspection, cleansing and repair of wounds
o Cold compresses are used in the early phase, followed by warm compresses
266
ϖ Immediate vision loss after injury is usually ______.
permanent
267
o Usually non emergent and require surgical repair
| o Detected by facial x-rays
ϖ Orbital Fractures
268
o Would do an xray or CT to detect
o Surgical intervention is directed at preventing further ocular injury and maintain the integrity of the affected areas
o Cultures are usually obtained, and the pt is placed on prophylactic IV antibiotics that are later changed to ones in a n oral form
ϖ Foreign Bodies
269
ϖ Occurs with occupations injuries, contact sports, weapons, assaults, motor vehicle accidents, and explosions
occular trauma
270
ϖ Two main types of ocular trauma include
chemical burns and foreign objects in the eye
271
what to do with chemical burns
o Immediately irrigate the eye with tap water or normal saline
o pH of the eye should be assessed
272
what to do with foreign bodies
o No attempt should be made to remove it
o The object should be protected from jarring or movement to prevent further ocular damage
o Wouldn’t want to put any type of pressure or patch on the affected eye
273
Splash injuries medical management
irrigate with NS
ATBs
tetanus antitoxin
any topical ophthalmic meds must be sterile
274
ϖ Foreign bodies and corneal abrasions medical management
removed by physician
| ATBs
275
is a common cause of corneal abrasion
o Contact lens wear
276
o Topical anesthetic eye drops must not be given to the patient to take home for repeated use after corneal injury because their effects mask further damage, delay healing, and can lead to ____ ____
corneal scarring
277
o Most penetrating injuries result in marked vision loss and usually have the following manifestations:
```
♣ Edema of the conjunctiva
♣ Conjunctival laceration
♣ Shallow anterior chamber with or without an eccentrically placed pupil
♣ Hyphema
♣ Vitreous hemorrhage
```
278
(blood within the anterior chamber)
hyphema
279
– Should avoid an MRI because if it’s metal it could further damage the patient
ϖ Intraocular Foreign Body
280
result in the most severe injury because they penetrate the ocular tissues rapidly and continue to cause long-term damage – can also cause increased IOP
o Alkali burns
281
generally cause less damage because the precipitated necrotic tissue proteins form a barrier to further penetration and damage
o Acids (bleach, car batteries, refrigerant)
282
– Burns related to heat or reflections from snow, sun gazing, etc.
ϖ Thermal Injury
283
treatment for thermal injury
o Antibiotic agents and a pressure patch for 24 hours constitute the treatment of mild injuries
284
HEARING LOSS Can be ___, ____, ____, or ____.
partial, total, congenital, or acquired
285
risk factors for hearing loss
```
ϖ Family hx of sensorineural impairment
ϖ Congenital malformations of the ear
ϖ Low birth weight—esp. NICU babies
ϖ Use of ototoxic medications
ϖ Recurrent ear infections
ϖ Bacterial meningitis
ϖ Chronic exposure to loud noises
ϖ Perforation of the tympanic membrane
ϖ Aging
ϖ
```
Lesions in outer, middle, or inner ear
ϖ
Central auditory pathways
286
symptoms of hearing loss
```
speech deterioration
fatigue
indifference
social withdrawal
insecurity
indecision and procrastination
suspiciousness
false pride
loneliness and unhappiness
tendency to dominate the conversation
```
287
ototoxic substances
```
diuretic agents
chemo
antimalarial agents
chemicals
aminoglycoside ATBs
ATBs
metals
```
288
4 types of hearing loss
conductive hearing loss
sensorineural hearing loss
mixed hearing loss
functional hearing loss
289
o Anything that disrupts sounds from external canal to internal ear
o Equal hearing loss at all frequencies
conductive hearing loss
| `
290
what will help with conductive hearing loss
talking loud or hearing aids
291
conductive hearing loss can include:
```
Obstruction of external ear canal
Impacted cerumen
Edema due to infection (bad ear infection)
Perforated tympanic membrane
Disruption of bone in the ear
```
292
o May effect inner ear, auditory nerve or auditory pathways in the brain
o Nerve problem – sound waves are interpreted correctly, but inner ear has lost the ability to receive or interpret the sounds
ϖ Sensorineural Hearing Loss
293
ϖ Sensorineural Hearing Loss can be caused by:
```
♣ Loud noise exposure
♣ Ototoxic drugs/Chemotherapy
♣ Prenatal exposure to rubella
♣ Viral infections
♣ Meningitis
♣ Trauma
♣ Aging
```
294
do hearing aids and talking loud help sensorineural hearing loss?
NO because they can't hear high frequency tones!!
295
– Gradual hearing loss that occurs throughout life
ϖ Presbycusis
296
ϖ Presbycusis is associated with what type of hearing loss?
sensorineural hearing loss due to degenerating cochlea
297
o Inability to hear high frequency sounds, followed in time by the loss of middle and lower frequencies
o Hearing aids are useful
Presbycusis
298
sx to watch for with presbycusis
cupping of an ear with hand
difficulty understanding others
need to see speaker while talking
299
diagnostic tests for hearing loss
```
o Rinne and Weber tests
o Audiometry
o Speech audiometry
o Tympanometry
o Acoustic reflex testing
```
300
o Makes sounds louder, but does not improve a patients ability to discriminate words or understand speech
hearing aids
301
is the only part of the hearing aid that may be washed frequently
• The ear mold
302
• Wash ear mold how often and with what
daily with soap and water
303
• Check for malfunctions with hearing aids:
o Is the switch on properly?
o Are the batteries charge and positioned correctly?
o Is the ear mold clogged w/ cerumen?
304
common complications with hearing aids
external otitis media and pressure ulcers in the external auditory canal
305
ϖ Inner ear is called the ____.
labyrinth
306
is the fluid within the ear canals and in the inner ear that helps maintain equilibrium
ϖ Endolymph
307
ϖ When this area becomes inflamed, balance is effected and hearing loss can occur
inner ear
308
ϖ Inner ear disorders can affect what 2 things?
equilibrium and perception of sound
309
used frequently by patients and health care providers to describe any altered sensation of orientation in space
o More common in women and in older adults
ϖ Dizziness –
310
the misperception or illusion of motion of the person or the surroundings
o Describe it as a spinning sensation or say they feel as though objects are moving around them
Vertigo –
311
is a failure of muscular coordination and may be present in patients with vestibular disease
ϖ Ataxia
312
involuntary rhythmic movement of the eyes
ϖ Nystagmus –
313
ϖ Buzzing, roaring or ringing sound in the ear with no noise associated with it
ϖ Can be associated with conductive or sensorineural hearing loss
tinnitus
314
what meds can cause tinnitus
aspirin, quindien or qulaididne toxicity
315
what else can cause tinnitus
obstruction in the ear,
possibly infections,
Meniere’s disease
316
ϖ Inflammation of inner ear
| ϖ Can be caused by bacteria and other viruses
Labyrinthitis (otitis internia)
317
common cause of labyrinthitis (otitis interna)
viral
318
common viruses that cause Labyrinthitis (otitis internia)
mumps, rebella, rubeola, and influenza
319
ϖ Anyone who has nystagmus, vertigo, or labyrinthitis is at risk for _____
falling
320
ϖ An abnormality in the inner ear fluid balance
ϖ More common in adults, onset generally seen when adults reach their 40s, but symptoms begin between ages 20 and 60
Meniere’s Disease
321
Meniere’s Disease is caused by:
a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct
322
sx of miniere's disease
♣ Fluctuating , progressive sensorineural hearing loss
♣ Tinnitus or a roaring sound
♣ A feeling of pressure or fullness in the ear
♣ Episodic incapacitating vertigo, often accompanied by nausea and vomiting
323
most troublesome complaint with meniere's disease:
vertigo
324
ϖ uses bone conduction to test lateralization of sound; detects for unilateral hearing loss
o Tunic fork placed on the patients head or forehead
weber test
325
ϖ useful for distinguishing between conductive and sensorineural hearing loss; move vibrating tuning fork between two positions:
o 2 inches from opening of ear canal (for air conduction)
o Against the mastoid bone (for bone conduction)
Rinee test
326
ϖ Abnormal electrical discharges from the brain
ϖ “Episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) that result from sudden excessive discharge from cerebral neurons”
seizure disorders
327
3 main types of seizures:
generalized
partial
unknown
328
generalized characteristics:
whole brain
| whole body
329
partial seizures:
1 side of brain
| 1 side of body
330
```
ϖ only a finger or hand may shake
o Only affects one side of the body
o Mouth may jerk
o Dizziness
o Unintelligible talk
o Unusual or unpleasant sights, sounds, odors, or tastes
```
simple partial seizures
331
do simple partial seizures have LOC
NO
332
ϖ patient remains motionless or moves automatically but inappropriately for time and place
o May experience excessive fear, anger, elation or irritability
o Patient does not remember episode when over
complex partial seizures
333
do complex partial seizures have LOC
they may/may not
334
ϖ ) involves whole brain; effects whole body
| o Intense rigidity followed by alternating muscle relaxation & contraction
Generalized seizures (Grand mal)
335
produced by simultaneous contractions of diaphragm and chest muscles—need to monitor respiratory status
in generalized grand mal seizures
o “Epileptic cry”
336
characteristics for generalized grand mal seizure
chew their tongue
| incontinent of urine and feces
337
vital signs with seizures
tachy/bradycardia
HTN
ST segment depression (ischemia)
338
Status epilepticus and repetitive seizures
| can cause ?
pulmonary edema for up to 72hrs
339
generalized grand mal seizures typically last
1-2 minutes
340
• After 1-2min, convulsive movements begin to subside
pt relaxes and lies in deep coma, breathing noisily
postictal state
341
what majorly leads to death during postictal state
respiratory
342
biggest concern with any seizure
airway!!!
343
triggers for seizures
```
flashing lights
loud noises/music
stress
fatigue
alcohol consumption
constipation
hypo/hyperventilation
menstruation
```
344
o Occurrence of an ____—premonitory or warning sensation, which can be visual, auditory, or olfactory
aura
345
♣ If patient starts seizing in the hall,
try to ease them to the ground—DON’T TRY TO HOLD THEM UP
346
o involuntary motor activity, such as lip smacking or repeated swallowing during a seizure
automatisms
347
o Incontinence of urine or stool (Usually indicator of _______ seizure)
generalized
348
o How to Prevent complications after the seizure:
```
side lying
HOB elevated
suction
oxygen
lowest position with 2-3 rails up and padded
```
349
ϖ Group of syndromes characterized by unprovoked, recurring seizures
ϖ Defined as recurrent stereotypical seizures history of 2 or more seizure
epilepsy
350
(Anything that causes seizures, can cause _____
epilepsy)
351
risk factors for epilepsy
• Lesions of CNS (tumors)
• Meningitis or encephalitis (brain infections)
• Cerebral/brain tumors
• Stroke
• Anoxia
• Alcohol or drug abuse
• Toxin exposure—carbon monoxide, lead poisoning
• Degenerative diseases
• Fever; Infection (bacterial, viral, parasitic)
• Endocrine disorder (hypo/hyperglycemia)
• Birth defects, congenital malformations, genetics
Head injuries, brain trauma—
352
main cause of epilepsy
head injuries/brain trauma
353
ϖ 70% of all epileptic cases are considered ______ – cause UNKNOWN
idiopathic
354
diagnosis of epilepsy
MRI
EEG
SPECT
355
used to detect structural lesions such as focal abnormalities, cerebrovascular abnormalities, and cerebral degenerative changes
ϖ MRI
356
o Additional tool that is sometimes used in the diagnostic workup—can detect abnormal electrical activity in brain
o Useful for identifying the epileptogenic zone so that the area in the brain giving rise the seizures can be removed surgically
SPECT
357
ϖ Women with epilepsy often note and increase in seizure frequency during ____.
menses
358
Effectiveness of contraceptives is decreased by ____-_____ medications
anti-seizure
359
___ ____ is associated with long-term use of antiseizure medications
Bone loss
360
surgical management for epilepsy
removal of tumor/abscess
vagal nerve stimulation
361
o may be used—tricks body into not having seizures
♣ Generator may be implanted under the clavicle
♣ Device is connected to the vagus nerve in the cervical area where it delivers electrical signals to the brain to control and reduce seizure activity
vagal nerve stimulation
362
vagal nerve stimulation doesn’t prevent seizure, it just ?
diminishes severity of it
363
if a patient has epilepsy you can't drive for _____ months
6 months
364
education to send home with patient with epilepsy
```
NO baths
NO excessive exercise
avoid extreme hot/cold temps
NO alcohol
need adequate sleep!!
```
365
what labs should be drawn frequently with epilepsy
liver enzymes and CBC
366
ϖ Series of generalized seizures that occur without full recovery of consciousness between attacks
STATUS EPILEPTICUS
367
STATUS EPILEPTICUS o May be of any type –but usually ?
generalized tonic-clonic
368
o Worried about repeated episodes of cerebral anoxia and edema with status epileptics because it can lead to....
irreversible and fatal brain damage
369
wit STATUS EPILEPTICUS; May have pulmonary edema for up to ____ hours
72
370
may occur if convulsive activity not halted with status epilepticus
```
o Hypoxia,
acidosis,
hypoglycemia,
hyperthermia,
exhaustion and
brain damage
```
371
main priority with status epilepticus
STOP the seizure with medication!!!!!
372
ϖ One of the most common of all physical complaints
headaches
373
classification of headaches:
primary
| secondary
374
not associated with a pathologic cause
o Primary HA
375
ex of primary HA
migraine, cluster HA, tension HA
376
have known etiology
Secondary HA
377
ex of Secondary HA
o Meningitis, Tumors, Subarachnoid hemorrhage, Aneurysm, Stroke, Severe HTN, Head injuries, Brain surgery, Meds, Low BS
378
• Complex symptoms characterized by periodic and recurrent attacks of severe HA lasting from 4-72 hours in adults
Migraine
379
migraines are more common in?
women
380
what causes migraines?
cerebral blood vessels narrowed and decreased blow flow to brain
381
triggers for migraines
o rapid changes in blood glucose levels, menstrual cycles, depression, sleep deprivation, overuse of certain medications stress, emotional excitement, fatigue, alcohol intake, bright light stimulants, food high in tyramine (smoked foods), nitrates, or milk products
382
4 phases of migraines
prodrome phase
aura phase
headache phase
recovery phase
383
o Symptoms that occur hours to days before a migraine
♣ Depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea or constipation, N/V before
Prodrome Phase:
384
♣ Visual disturbances (light flashes and bright spots) are most common and may be hemianopic (only half of the vision field)
♣ Other symptoms numbness and tingling of lips, face, or hands; mild confusion; slight weakness of extremity; drowsiness or dizziness
aura phase
385
o Duration varies, ranges from 4-72hrs
♣ Vasodilation and decline in serotonin levels occur throbbing headache (unilateral in most) intensifies over several hours
headache phase
386
* Seen 5 times more frequently in men
| * Similar to migraines but only last 45 minutes or so (few minutes to a few hours)
cluster headache
387
cluster headaches incur in cluster periods for ___ or ____
weeks or months
388
sx of cluster headaches
unilateral burning pain around eyes
facial edema
ptosis
389
* Tend to be chronic and less severe than migraine
* Probably the most common type of headache
* Produced by stress—Relaxation can help to treat
tension headache
390
ϖ Common slowly progressing neurologic movement disorder that eventually leads to disability
o Affects men more than women
o Usually occurs after the age of 50
Parkinson's Disease
391
ϖ The degenerative or _______ form of Parkinson’s disease is the most common; there is also a secondary form with a known or suspected cause
idiopathic
392
cause of parkinson's is unknown, however there is a ____ component
genetic
393
main problem with parkinson's disease
not enough dopamine
394
symptoms of parkinson's:
| TRAP
tremor
rigidity
akinesia/bradykinesia (slow movement)
postural instability
395
Tremors in parkinson's may manifest as?
pill rolling
396
transient inability to perform active movement with parkinson's
♣ Freezing phenomenon—
397
with parkinson's: Face becomes increasingly ____ and expressionless, and the frequency of blinking ______
masklike; decreases
398
how to parkinson's patients stand
head bent forward and walks with propulsive gait
399
o Autonomic Symptoms of parkinson's
```
♣ Excessive and uncontrolled sweating
♣ Paroxysmal Flushing
♣ Orthostatic hypotension
♣ Gastric and urinary retention
♣ Constipation
♣ Sexual dysfunction
```
400
o Psychiatric Changes for parkinson's
♣ Depression and anxiety
♣ Dementia (progressive mental deterioration)
♣ Delirium
♣ Auditory or visual hallucinations
401
• surgical implantation of an electrode into the brain in either the globus pallidus or subthalamic nucleus.
o Stimulation of these areas may increase dopamine release or block anticholinergic release, thereby improving tremor and rigidity with parkinson's
Deep Brain Stimulation (DBS
402
♣ ongoing research
| • Transplanting porcine neuronal cells, human fetal cells, and stem cells to replace degenerated striatal cells.
Neural Transplantation
403
Chronic, progressive, heredity disease of the nervous system that results in progressive involuntary choreiform (chorea) movement and dementia
Huntington Disease
404
: constant, rapid, jerky, involuntary, purposeless movements
o Chorea
405
Chorea Affects walking, sleeping, EVERYTHING; so _____ is priority
safety
406
usual age for Huntington's
35-45
407
sx of Huntington's
chorea
impaired voluntary movement
intellectual decline
personality changes
408
huntington's Gait
becomes disorganized and ambulation eventually is impossible a wheelchair usually becomes necessary
409
Huntington's patient's usually die within ___-___ years
10-20 years
410
Huntington's death is usually due to
```
HF
pneumonia
infection
falling
choking
```
411
diagnosis of Huntington's
positive family history
| genetic marker
412
ϖ Neuronal (nerve) damage occurs primary in cerebral cortex and results in decreased brain size
o Progressive, irreversible, degenerative neurological disease characterized by gradual loss of cognitive function and disturbances in behavior and affect
ALZHEIMERS DISEASE
413
ALZHEIMERS DISEASE can occurr in as young as ____ but not usually before ___ years old
40; 65
414
Alzheimers disease is a Complex brain d/o caused by various factors:
Genetics, neurotransmitter changes, vascular abnormalities, stress hormones, circadian changes, head trauma, and presence of seizure disorders
415
diagnosis of Alzheimers
autopsy brain biopsy shows a decrease in brain size
416
o 1st signs of Alzheimers
Forgetfulness and memory loss (usually mistaken for normal signs of aging)
417
other symptoms Alzheimers
o Lose ability to recognize familiar objects, places, or faces
Conversation becomes difficult due to cognitive decline
Personality changes
418
o Death with Alzheimers results from complications of
pneumonia, dehydration, respiratory failure
419
nursing management of Alzheimer's
supporting cognitive function
| providing physical safety
420
increased confusion at night
| seen with Alzheimer's
♣ Sundown syndrome—
421
ϖ Also known as “Lou Gehrig’s Disease” Professional baseball player who first had it
ALS
422
ϖ Progressive degeneration of both upper and lower motor neurons
ALS
423
diagnosis of ALS
o The prognosis generally is based on the area of CNS involvement and the speed with which the disease progresses
424
chief symptom of ALS
```
fatigue
progressive muscle weakness
cramps
fasciculation
incoordination
```
425
twitching
fasciculation
426
does cognitive function decline with ALS?
NOOO
427
cure for ALS?
NONE
428
preop cervical discectomy
evaluate labs
| get baseline functioning (strength bilaterally, ROM)
429
ND of cervical discectomy
acute pain
impaired physical mobility
deficient knowledge
430
post op cervical discectomy
kept flat for 12-24 hours
431
♣ If patient had bone fusion with bone removed from iliac crest, considerable pain pay be experienced at ___ ____
donor site
432
a leak with Cervical Discectomy indicates
high risk for meningitis
433
ϖ People who survived the polio epidemic of the 50’s are now developing new symptoms of weakness, fatigue, and musculoskeletal pain
post polio syndrome
434
nursing interventions with post polio syndrome
management of fatigue
pain and progressive loss of muscle strength
pain meds
