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Adult Health Exam 4 > Adult 4 > Flashcards

Adult 4 Flashcards

1
Q

what are 2 types of strokes

A

hemorrhagic and ischemic

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2
Q

what is a hemorrhagic stroke

A

ruptured artery or aneurysm, poor prognosis

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3
Q

name the 3 types of hemorrhagic strokes

A

nontraumatic subarachnoid, intracerebral, and intraventricular

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4
Q

cause of nontraumatic subarachnoid hemorrhage

A

ruptured aneurysm, AV malformation

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5
Q

manifestations of a hemorrhagic stroke

A

severe “thunderclap”, stiff/pain in the neck, photosensitivity, decreased LOC, seizures

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6
Q

surgical interventions for hemorrhagic stroke

A

titanium clips, platinum coils, wrapping of aneurysm

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7
Q

complications of a hemorrhagic stroke

A

cerebral vasospasms, ischemic strokes

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8
Q

treatment of hemorrhagic stroke

A

Triple H: HTN, hypervolemia, hemodilution

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9
Q

2 types of ischemic strokes

A

thrombolytic and embolic

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10
Q

what is a thrombolytic stroke

A

blood cot forms and shuts off arterial blood supply; ischemia is distally to clot

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11
Q

what is an embolic stroke

A

clot travels from somewhere else in the body; it gets stuck in the artery; ischemia is distally to clot

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12
Q

what is the only med given for an ischemic stroke

A

ateplase

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13
Q

what does alteplase do to the clot

A

dissolves already formed clots, destroys fibrinogen from other clot factors

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14
Q

what is the time frame for alteplase

A

under 80: 4.5hrs
over 80: 3hrs

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15
Q

contraindications to alteplase

A

prior hx of hemorrhagic stroke, ischemic within 3 months, known cerebral lesions (AV malformations)

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16
Q

considerations AFTER giving alteplase

A

avoid causing bleeding, little venipuncture, monitor changes in LOC and VS, alteplase is to be given ALONE

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17
Q

what determines stroke manifestations

A

area of the brain deprived of oxygen

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18
Q

manifestations= same side as stroke

A

false; opposite

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19
Q

what is the left cerebral hemisphere responsible for

A

language, math, analytical thinking

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20
Q

S/S of left hemisphere stroke

A

expressive/receptive aphasia, agnosia, agraphia, alexia, right sided paralysis, slowed behavior, visual changes, hemianopsia

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21
Q

what is angosia

A

lack of recognizing familiar objects

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22
Q

what is agraphia

A

inability to write

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23
Q

what is alexia

A

inability to read

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24
Q

what is hemianopsia

A

only seeing 1/2 of visual field

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25
Q

what is the right hemispheres responsibility

A

spatial awareness, vision, proprioception

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26
Q

S/S of right hemisphere stroke

A

altered deficit perception, unilateral neglect syndrome, loss of depth perception, poor impulse/judgement, left sided paralysis, hemianopsia

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27
Q

diagnostic testing for strokes

A

CT, scan, MRI, cerebral angiography, lumbar puncture, glasgow coma scale

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28
Q

when should the CT scan be done and what does it determine

A

within 25 min of arrival to ED, determines type of stroke and treatmen

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29
Q

what does the lumbar puncture determine

A

if positive for blood in CSF= hemorrhagic stroke

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30
Q

what does the cerebral angiography determine

A

hemorrhage or vessel abnormality (AV malformation)

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31
Q

what does along with a cerebral angiography that finds the clots

A

thrombectomy

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32
Q

what time frame should the thrombectomy be performed

A

within 24hrs of onset

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33
Q

what does the MRI identify in strokes

A

necrosis, ischemia, edema

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34
Q

BP to notify to provider (stroke)

A

systolic over 180 and diastolic over 110

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35
Q

O2 to notify to provider (stroke)

A

less than 92%

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36
Q

Temp to notify to provider (stroke)

A

elevated; increased ICP

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37
Q

blood sugar to notify the provider (stroke)

A

hyperglycemia; poor neuro outcomes

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38
Q

post stroke precautions

A

seizure precautions

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39
Q

what is the nursing care post stroke

A

HOB 30 degrees, assess gag and swallow, request swallow screen, thickened liquids, change in food level, no distractions when eating, prevent immobility complications, ROM q2, safe environment, chew on unaffected side, dressed affected side first

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40
Q

what is a seizure

A

abnormal, uncontrolled, electrical discharge of neurons in the brain

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41
Q

what is epilepsy

A

chronic, recurring, abnormal brain activity (2 or more seizures with no identifiable cause)

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42
Q

what is a tonic-clonic seizure

A

tonic first (muscle stiffness), then LOC, followed by 1-2 mins of jerking movements (clonic)

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43
Q

what can occur during a tonic clonic seizure

A

cyanosis, breathing may stop or be irregular during clonic, biting cheeks or tongue, incontinence

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44
Q

what are the types of generalized seizures

A

tonic and clonic

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45
Q

what are the atypical seizures

A

myoclonic (muscle jerking) atonic (sudden loss of strength)

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46
Q

what are the local/focal/partial seizures

A

complex and simple partial seizures

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47
Q

what is a complex partial seizure

A

automatisms (lip smacking, touching clothes), amnesia

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48
Q

what is a simple partial seizure

A

no LOC, has unusual sensations

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49
Q

diagnostic tests for seizures

A

labs (ETOH, HOV, toxins), EEG (electrical brain issues), CT, MRI, PET [determine other causes]

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50
Q

what are the nursing interventions DURING a seizure

A

keep pt safe, position to ensure patent airway, oral suction prn, turn to side to prevent aspiration, loosen restrictive clothing

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51
Q

what should not be done during a seizure

A

do not open jaw, restrain, insert oral airway, use tongue blade

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52
Q

what are the nursing interventions AFTER a seizure

A

post ictal care, side lying position, check for injuries, assess neuro, reorient and remain calm, ask about auras/triggers

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53
Q

what medications are used for seizures

A

anti-epileptics (phenytoin)

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54
Q

what do pts avoid when taking phenytoin

A

oral contraceptives and warfarin

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55
Q

nursing implications when taking phenytoin

A

take at same time every day, monitor levels, some cause gingival hyperplasia

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56
Q

what is the ONLY procedure done for partial seizures

A

vagal nerve stimulator (implanted in cell wall, magnet held to chest)

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57
Q

what should the pt avoid after the placement of a vagal nerve stimulator

A

microwave ovens, shortwave radios, MRI, ultrasounds

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58
Q

what is the procedure used for BOTH generalized and partial seizures

A

conventional surgery (removes part of brain that is causing seizure)

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59
Q

if a pt cannot have conventional surgrey then what

A

partial corpus callosotomy

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60
Q

what is status epilepticus

A

repeated seizure activity within 30 min or a single seizure lasting longer than 5 mins

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61
Q

nursing actions during a status epilepticus

A

IV access, EKG monitoring, pulse ox, give IV diazepam or lorazepam, then phenytoin or fosphenytoin

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62
Q

what is a sprain

A

injury to a ligament

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63
Q

what is a strain

A

injury to a tendon/muscle

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64
Q

nursing intervention for sprain

A

RICE (rest, ice, compression, elevation)

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65
Q

Sprain 1st degree

A

mild, stretching or minimal tearing of ligament, pain/edema, joint function intact

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66
Q

Sprain 2nd degree

A

moderate ligament tear, pain/swelling, bruising, altered weight bearing

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67
Q

Sprain 3rd degree

A

severe tear of ligament (complete), severe pain/bruise/swelling, no ambulation

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68
Q

nursing interventions of strains

A

cold/heat application, exercise, activity limitations, anti-inflammatory or muscle relaxants

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69
Q

Strain 1st degree

A

mild inflammation/pain, normal ROM, swelling, bruising

70
Q

Strain 2nd degree

A

moderate, partial tear of tendon/muscle fibers, impaired muscle function

71
Q

Strain 3rd degree

A

severe, ruptured muscle/tendon, severe pain (may need surgery)

72
Q

post op care for arthroplasty

A

immobile for 4-6 wks, needs physical therapy

73
Q

what is an arthroplasty

A

reconstruction or replacement of joint

74
Q

how does a nurse assess for a sprain or strain

A

inspection, palpation, neurovascular 7Ps

75
Q

List the 7 P’s

A

pain, pallor, pulselessness, pressure, protrusion, paralysis, paresthesia

76
Q

diagnosis of both sprains and strains

A

MRI, x-ray, history, ultrasound

77
Q

complications post sprain and strain

A

instability, tendonitis, bursitis

78
Q

what are 2 types of meniscus tears

A

medial and lateral

79
Q

manifestations of a meniscus tear

A

pain, fluid in the joint

80
Q

diagnostic tests for meniscus tear

A

MRI, physical exam, McMurray and Steinman test, radiograph

81
Q

what is McMurray

A

flexed knee as much as possible

82
Q

what is Steinman

A

rotating leg inward and outward

83
Q

what is not recommended for meniscus recovery

A

complete immobilization

84
Q

surgery for meniscus

A

arthroplasty

85
Q

when are casts applied after fracture

A

when swelling goes down

86
Q

nursing implications for cast

A

monitor neuro q1hr for 24hrs, ice for 24-48hrs, avoid setting on hard or sharp objects, watch for drainage

87
Q

pt teaching for casts

A

dont put stuff down cast use cool air from hair dryer, cover in plastic bag to avoid moisture

88
Q

what is traction in fractures

A

pulling force to promote and maintain alignment

89
Q

what is included in the traction order

A

type, weight, if can be removed when doing nursing tasks

90
Q

3 types of traction

A

manual, skin (straight/running), skeletal (balanced suspension)

91
Q

what is skin (straights/running)

A

movement pts body can alter the traction (decrease muscle spasms, immobilzes prior to surgery)

92
Q

what is skeletal (balanced suspension)

A

screws inserted into bone, may use heavier weight or longer traction time

93
Q

how often do the ropes need to be changed in traction

A

q8-12 hrs

94
Q

how should pins be cared for

A

inspect site for infection, done once per shift or twice depending on protocol, use diff swab for each pin, use dry gauze

95
Q

What should the nurse do for a traumatic amputation limb

A

apply direct pressure, elevate the extremity above the heart

96
Q

what should nurse to with amputated limb

A

wrap in sterile gauze, place in baggie, submerge in ice

97
Q

how should post op amputated be postitioned

A

dependent to promote blood flow

98
Q

the nurse should compare _____ to the most proximal and unaffected extremity

A

pulses

99
Q

what med is used to reduce phantom limb pain the 1st week of amputation

A

calcitonin

100
Q

what can indicate a complication post amputation

A

swelling above stump

101
Q

what is a complication of an amputation

A

flexion contractures

102
Q

nursing care for avoiding flexion contractures

A

ROM exercises, proper positioning post op, elevate in 1st 24-48hrs (reduce swelling), lie prone for 20-30 mins several times a day, discourage prolonged sitting

103
Q

what is carpal tunnel

A

repetitive motions of the wrist causing inflammation on tendons and ligaments (compression on median nerve)

104
Q

manifestations of carpal tunnel

A

sharp pain, numbness, tingling in hands, commonly worse at night, decreased grip strength

105
Q

diagnostic test for carpal tunnel

A

phalens test, tinels sign (tapping on median nerve), nerve conduction

106
Q

treatment for carpal tunnel

A

modify work environment, ROM, ultrasound therapy, NSAIDs, steroid injections, splinting at night, OT

107
Q

carpal tunnel surgery availiable

A

carpal tunnel release surgery

108
Q

how long should hand movement be restricted after carpal tunnel surgery

A

4-6 months

109
Q

what needs to be reported immediately post op carpal tunnel

A

neurovascular status

110
Q

lifespan of arthroplasty

A

10-15 yrs

111
Q

contraindications to arthroplasty

A

recent or active UTI, arterial impairment, inability to follow post op regimen

112
Q

pre op tests done for arthroplasty

A

blood work, chest x-ray, ECG

113
Q

what modifications need to be made for a post op hip replacement

A

raised toilet seat, long shoehorn, dressing sticks, straight chair with arms, abduction pillow between legs

114
Q

what should post op hip replacement be taught

A

early ambulation is important, avoid 90 degree flexion, do not cross legs, do not internally rotate toes, avoid turning on operative side

115
Q

education post op knee replacement

A

have a continuous passive motion machine, flexion of knees limited to avoid contractures, place single pillow under lower calf/foot, limit kneeling indefinitely

116
Q

complications of arthroplasty

A

venous clot, joint dislocation, infection, anemia, neurovascular compromise

117
Q

cause of encephalitis

A

viral infection, vector borne viral infections, fungal infections

118
Q

encephalitis manifestations

A

fever, neurological deficits, headache, photophobia, phonophobia, stiff neck

119
Q

how is encephalitis diagnosed

A

lab tests, lumbar puncture, EEG, CT, MRI

120
Q

medications given for encephalitis

A

antivirals and antifungals, stool softeners and laxative PRN

121
Q

what degree should the bed be kept in for encephalitis

A

30-45

122
Q

nursing care for encephalitis

A

dim lights, quite environment, reposition, every 2hrs, seizure precautions

123
Q

what is amyotrophic lateral sclerosis AKA Lou Gehrig’s disease

A

cause unknown, rapidly progressing and fatal disease affecting voluntary muscle control with no cognitive impairment

124
Q

once the diaphram and chest wall are affected what will the pt need

A

artificial airway

125
Q

manifestations of ALS

A

muscle cramps/weakness, weakness in one part of body, slurred speech, dysphasia, spasticity, flaccidity

126
Q

how ALS diagnosed

A

lumbar puncture, CT, MRI, hx, tumors can mimic the s/s so rule other causes out

127
Q

ALS: meds used for muscle cramps

A

bacolfen

128
Q

ALS: meds used for not straining/muscle weakness

A

stool softeners

129
Q

ALS: meds used for weakness and fatgue

A

CNS stimulants

130
Q

ALS: meds for slowing the disease progression

A

riluzole

131
Q

ALS respiratory related complications

A

aspiration, pneumonia, respiratory failure, PE

132
Q

ALS complications related to immobility

A

DVT, pressure sores

133
Q

ALS nursing care

A

ROM, meds, HOB elevated, discuss ventilator support when s/s are mild and can be informed, report swallow difficulty

134
Q

how brain tumors classified

A

cells or tissue or origin and location

135
Q

location classification of brain tumor: supratentorial

A

occurs above tenrotium cerebellum

136
Q

location classification of brain tumor: infratentorial

A

below brainstem and cerebellum

137
Q

brain tumor manifestations from increased pressure on brain

A

increased ICP, decreased outflow of CSF, neurological deficits, pituitary gland tumors= endocrine function

138
Q

brain tumor manifestations

A

dysarthria, dysphagia, positive romberg, positive babinski, vertigo, hemiparesis, cranial nerve dysfunction, papilledema

139
Q

possible findings for supraintentorial specificly

A

sever headache, seizures, loss of voluntary movement, change in personality and cognitive function, N/V

140
Q

possible findings for infratentorial specificly

A

hearing loss/tinnitus, facial drooping, diff swallowing, nystagmus, cross eyed, decreased vision, ANS dysfunction, cranial nerve dysfunction

141
Q

types of brain tumors: primary malignant

A

originate in neurological tissue, rarely metastasize outside of brain

142
Q

types of brain tumors; secondary malignant brain tumor

A

metastasis from primary cancer elsewhere in body

143
Q

types of brain tumors: benign brain tumors

A

meninges or cranial nerves= no metastasis, has distinct boundaries

144
Q

brain tumors diagnosed

A

x-ray, CT, MRI, EEG, lumbar puncture, cerebral biopsy

145
Q

when should a lumbar puncture not be performed

A

increased ICP, can cause brain herniation through the foramen magnum

146
Q

what medication for cerebral biopsy must continue

A

anticonvulsants

147
Q

what med should pt getting a cerebral biopsy discontinue how long before procedure

A

ASA 72 hrs

148
Q

headache brain tumor what med

A

non opioid pain meds

149
Q

reduced cerebral edema (brain tumor med)

A

corticosteroids

150
Q

osmotic diuretic for brain tumor med

A

mannitol

151
Q

seizures for brain tumor med

A

anitconvulsants

152
Q

nausea brain tumor med

A

antiemetics

153
Q

what med should not be given to brain tumor pt

A

opioids; cause a change in neuro status during intoxication

154
Q

therapeutic procedure for brain tumor

A

craniotomy (partial or complete resection of tumor)

155
Q

when should pt discontinue the use of alcohol, NSAIDs, anticoagulation, tobacco

A

5 days prior

156
Q

post op wound dressing craniotomy

A

assess for drainage q1-2 hrs, should not have drainage

157
Q

how should pt with supratentorial tumor be positioned

A

HOB 30 degrees, head in neutral

158
Q

how should pt with intratentorial be positioned

A

flat, side lying, turn q2

159
Q

what are complications that can happen due to a brain tumor

A

SIADH, diabetes insipiduc

160
Q

what is myasthenia gravis

A

autoimmune disease causing a motor disorder with fluctuating, localized, skeletal muscle fatigue and weakness

161
Q

how is MG diagnosed

A

serological antibody testing, repetitive nerve stimulation test, tensilon test

162
Q

tensilon test?

A

give edrophonium IV, observe the weak muscles, if improve then returns to poor baseline= positive test

163
Q

adverse effect of edrophonium? reversal agent

A

bradycardia and bronchospasms (give atropine)

164
Q

what are med for MG

A

pyridostigmine, neostigmine, immunotherapy, cyclophophamide

165
Q

what surgery could help MG? who is qualified

A

thymectomy, pts less than 65 and within 3 yrs diagnosis

166
Q

what are 2 MG complications

A

myasthenic crisis, cholinergic crisis

167
Q

what is myasthenic crisis

A

exacerbation of weakness lasting 2 weeks resulting in respiratory failure (bacterial or viral infection)

168
Q

myasthenic crisis manifestations

A

tachycardia, flaccid muscles, pale/cool skin

169
Q

what is cholinergic crisis

A

occurs from over taking meds

170
Q

manifestations of cholinergic crisis

A

muscle twitching, sweating, pallor, excess secretions, small pupils

171
Q

what should the nurse do in the event of a cholinergic crisis

A

temporarily discontinue med

172
Q

nursing care/education for pt with MG

A

HOB elevated, meals when meds are at peak effect to prevent aspirations, rest periods, medical alert bracelets, avoid public spaces, get vax

Adult Health Exam 4 (1 decks)

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