Adv MS Test #3 Flashcards
scarring of the liver due to necrosis or chronic inflammation over time; liver tissue replaced by non-functional fibrotic tissue
Cirrhosis
condition often associated with another syndrome (ex-Down’s) in which head circumference is smaller than normal and will fail to grow
Microcephaly
Nsg interventions for autonomic dysreflexia
Elevate HOB 45 degrees notify MD cath to empty bladder
best indicator of renal function
creatinine
Hydrocephalus etiology
Congenital: CNS malformation (genetic, spina bifida/NTDs, tumors, intrauterine infection) Acquired: meningitis, brain tumors, aneurysm, trauma
pts with meningitis are put in
respiratory isolation
hepatitis dx
ELISA test for antibodies to id strain
homonymous hemianopsia
loss of half the visual field in both eyes
azotemia
increased urea in blood
s/s of chronic pancreatitis
recurring attacks wt loss malabsrption-steatorrhea
Type of CP with poor coordination, wide gait, and difficulty with quick, precise movements
Ataxic
s/s cholecystitis
RUQ pain, full feeling, may radiate to back abd distention–these can worsen after fatty meal pruritis due to bile salts in skin n/v obstructive jaundice dark urine and clay-colored stool
sudden and reversible loss of kidney function
acute kidney failure/acute kidney injury
these two Hep viruses are fecal oral transmitted, acute onset and self-limiting, associated with poor sanitation
HepA and HepE
Chiari malformation
cerebellum protrudes into spinal canal
most common form of meningitis, self-limiting
Viral (aseptic) Mumps, measles, herpes
constant EKG monitoring with SCI because
SCI can cause bradycardia, asystole
IN a child with a Wilm’s tumor, DO NOT
palpate abdomen
cholecystitis patho
bile flow obstructed bile chemically irritates gb causing autolysis and edema cells die, destended gb presses on bvs and decreases blood flow can result in gangrene, infection, perforation
RFs for liver cancer
HepC cirrhosis toxin exposure smoking alcohol abuse
causes of nephrotic syndrome
Primary: Minimal Change (etiology unknown) or congenital Secondary: due to a systemic disease that damages glomeruli (drug toxicity, hypersensitivity rxn, infection…)
s/s Chiari malformation
occipital HA: worsened by coughing, straining vomiting difficulty swallowing
to dx enuresis, inappropriate urination must occur
at least 2x/week for at least 3 mos in a child 5 yrs or older
Hydrocephalus s/s in children
**Urinary incontinence **Change in personality, memory loss HA n/v sunsetting uncoordinated gait
consequence if VP/VA shunt placement decreases IICP too rapidly
subdural hematoma
seizure with a blank stare that ends suddenly, can have automatisms, hyperventilation or flushing; flashing lights can provoke
Absence seizure
chronic progressive degenerative autoimmune disease; antibodies attack myelin sheath in white matter (axons) of CNS, plaques form, slowing impulse transmission to muscles
Multiple Sclerosis
acute exacerbation of MG due to infection or medication underdose; emergency
Myasthenic crisis–improves with Tensilon
ALS Dx
Muscle biopsy for tissue changes and loss of muscle fibers
s/s of AGN
Brown, tea-colored urine (d/t rbc’s in urine) HTN Circulatory congestion/Edema-periorbital, JVD, crackles, SOB decreased UO fever
HOB post of VA/VP shunt placement
initially flat (too avoid subdural hematoma formation) then 30
two types of gallstones
pigment stones–from unconjugated pigments; must be surgically removed cholesterol stones–d/t decreased bile acid synthesis or increased chol synthesis
These two blood-borne hepatitis viruses occur together
Hep B and Hep D
can result in permenant renal failure; often due to eating food contaminated with Ecoli, Shigella, Salmonella
Hemolytic Uremic Syndrome (HUS)
meningitis with a chronically draining ear is associated with
Strep pneumoniae
mild concussion
unconscious 30 min or less
condition in which kidneys are unable to remove metabolites and wastes from blood, resulting in F&E and A/B imbalances
kidney failure
Spina bifida lesion at L2 or above
wheelchair bound L2-L5 chair or braces lower, may need braces
Epilepsy def
condition of 2 or more unprovoked seizures vs. acute seizures d/t acute issue
chronic hepatitis (B,C,D) increase r/f
liver cancer
s/s septic meningitis
high fever, chills severe HA, drowsiness Photophobia n/v red/ purple spotted rash late sign: nuchal rigidity….confusion, seizures +Brudzinski’s sign (flexion of knees and hips with neck flexion) +Kernig’s sign (resistance to leg extension from flexed position)
most common cause of ARF
Acute Tubular Necrosis due to decreased perfusion to tubular cells, necrosis and cell sloughing with obstruction of tubules results is reversible, cells can regenerate
Stage of CRF with normal BUN/Creat and no s/s
Reduced Renal Reserve lifestyle changes here can increase function
stroke secondary to ruptured artery or aneurysm
Hemorrhagic stroke
RFs for septic meningitis
bacterial URI immunosuppression penetrating injury to CSF Overcrowded living conditions
stroke caused by a blood clot that forms on an atherosclerotic plaque in a cerebral artery
Thrombotic stroke (Ischemic-type)
Meds that can cause drug-induced hepatitis
Tylenol some antidepressants anesthetics anticonvulsants
no loss of consciousness, pt knows what it happening and is responsive; motor (eyes turn away, facial tic, arrested speech) or sensory (tingling, change in vision or hearing), or psychic (Deja Vu, emotion) symptoms
Simple Partial Seizure
Ketogenic diet
seizure-suppressing Hi FAT, low PRO, low CHO
total loss of respiratory function in SCI above
C4
acute benign facial paralysis due to compression of facial (7th cranial) nerve; usually unilateral
Bell’s Palsy
cirrhosis s/s
Edema (decreased albumin production) muscle wasting spider angiomas fetor hepaticus confusion, personality changes, asterixis-hand flap bruising ascites
can develop after SCI d/t loss of autonomic NS function below level of injury
Neurogenic shock
Complications of spinia bifida repair
CSF leak infection IICP, hydrocephalus hypothermia/dehdration (loss thru sac) tethered cord
pancreatitis patho
autodigestion of the pancreas from premature activation of digestive enzymes; can cause inflammation, necrosis, and hemorrhage
sudden transient mechanical injury to head with disruption of neural activity
concussion
CMs of Parkinson’s besides primary 4
Autonomic: flushing, hHoTN, urinary retention, constipation Emotional lability, cognitive changes, eventually dementia Dysphagia
Contagious form of meningitis with high mortality rate
Bacterial (septic) N. mengitides (meningococcal) S. pneumoniae (pneumococcal) also Hib, Ecoli
autoimmune disorder in which antibodies cause demyelination of nerves in the peripheral NS, resulting in ascending paralysis, often associated with an acute infection 10-14 d prior
Guillain-Barre Syndrome
IICP Tx
Osmotic diuretics (Mannitol) to decrease cerebral edema Hi dose barbituates or paralyzers to decrease metabolic demands Fluid restriction decompressive craniectomy if needed
ARF due to obstruction of urinary outflow & Causes
Postrenal Causes: kidney stones, tumors, BPH
ARF diet
low Na/K/Phos/Protein, high cal
Ischemic stroke can be reversed by
tPA within 4-6 hours of event
hemorrhagic stroke Tx
stop bleed, Sx evacuation if needed monitor for IICP, herniation avoid anticoagulants
wait this long to tell the extent of a spinal injury
72 h
CP developmental warning signs
Poor head control, absence of smiling in 3 month old Persistent primitive reflexes (Moro, tonic neck) Inability to sit without support by 8 mos stiff extremities, arching back; or limp, floppy body feeding difficulties use of only one side of body
seizure assessment
what happens before, after, and during how long does it last Fam Hx Hx of head trauma, birth complications, febrile seizures
Phase of AKI: original insult until s/s become apparent
Initiation Phase
Diuretic phase of AKI
gradual increase to high UO, lab values stabilize, renal function is still impaired–watch closely for dehydration as they can excrete but cannot concentrate urine
Nephroblastoma; rapidly growing solid tumor of kidney
Wilm’s tumor
s/s septic meningitis in infants
bulging fontanels irritablity high-pitched cry high fever without URI or OM vomiting
edrophonium (Tensilon) action
cholinesterase inhibitor; inhibits breakdown of ACh
CMs of microcephaly
*Mental retardation *seizures dwarfism decreased coordination other…
seizure with impaired consciousness (confused or unresponsive), amnesia of event; may have automatic movements, aura (sensory hallucinations, strong emotions); usually weak and sleepy after
Complex Partial seizure
often first sign of MG
Ptosis (eyelid drooping), blurred vision
Recovery phase of AKI
may take 3-12 mos return to normal lab values with slight decrease from baseline GFR
muscle cramps can occur after HD due to
change in electrolyte levels.
s/s VP/VA shunt malfunction
signs of IICP: HA, blurred vision n/v irritability, sleepiness
s/s MG
Ptosis, blurred vision masklike expression dysphagia head bobbing decreased vital capacity stress incontinence
primary causes of ATN
ischemia and nephrotoxins
Major CMs of ARF (3)
FVE—SOB, crackles, pulmonary edema Anemia Hyperkalemia
APSGN usually presents
10-21 days after strep infection
complications of prolonged bile flow obstruction
fat soluble vitamin deficiency decreased Vitamin K—increased r/f bleeding
No LP if ICP is increased because
the sudden change in pressure can result in brain herniation
Dx of NTDs
AFP at 15-20 weeks sono/amnio
seizure manifestations depend on
area of brain involved
Monitor after Whipple or pancreatectomy
monitor for peritonitis ng drainage should be serosanguinous; bloody or bile-tinged could signal problem
food high in folic acid
leafy greens, nuts, beans, citrus, cereal
early detection of CP
accurate growth charts and developmental milestone checks
s/s ALS
Early: weakness of face/tongue, fatigue while talking, dysphagia, dysarthria, facial tics; hand/arm weakness Later: Muscle weakness and atrophy leading to flaccid quadriplegia respiratory compromise Pt remain alert, trapped in body
most common tx for hydrocephalus
Shunt placement (VP or VA) flexible tube under skin with a one-way valve that brings CSF to peritoneal cavity or atrium, where it can be reabsorbed
walled off fibrous tissue cysts resulting from necrosis during pancreatitis attack; can ber very large and contain caustic fluid
pancreatic pseudocyst
s/s viral hepatitis
fever fatigue a/n/v abd pain gray colored stool joint pain jaundice
s/s of a concussion
HA n/v photophobia blurred vision
this form of hepatitis causes 1/3 of liver cancers and is the most common cause of chronic liver disease/reason for liver transplant
HepC
abnormal accumulation of CSF in the ventricles of the brain due to lack of reabsorption or increased production of CSF
Hydrocephalus
subdural hematoma
venous bleeding into space between dura and brain slower bleed than epidural; can be chronic, subchronic, or acute
Dx of cholecystitis
ERCP (r/f perforation, pancreatitis)
disorder involving 5th cranial nerve causing paroxysmal unilateral stabbing pain in face
Trigeminal neuralgia
Tubule changes due to ATN result in
a change in glomerular permeability causing abnormal reabsorption of filtrate
Complication of HD in which fluid is moved too fast and the shift in fluid causes cerebral edema, nausea, HA
disequilibrium syndrome
Type of CP with involuntary writhing movements, hyperactive facial muscles, drooling
Dyskinetic/atheoid
Right CVA characterized by
overestimation of abilities, denial of stroke, one-sided neglect syndrome loss of depth perception, poor impulse control and judgement Left hemiparesis or hemiplegia hemianopsia
classic concussion
unconscious less than 6h
CP Patho
prenatal injury: anoxia, brain anomalies anoxia during birth postnatal injury: cerebral infection/meningitis, head trauma
MS Dx
multiple MRIs to see progression
primary causes of chronic pancreatitis
alcohol abuse, smoking and biliary tract disease (gallstones block CBD/pancreatic duct junction)
all women of child-bearing age should get this much folic acid per day to avoid NTDs
0.4 mg/d especially 2 mos prior to conception and entire first trimester
uremia
more serious azotemia, when increased nitrogenous wastes in blood cause toxic s/s
4 stages of CRF
- Reduced renal reserve (GFR 60-90% of normal) 2. Renal Insufficiency (30-60%) 3. Renal Failure (15-30%) 4. End Stage Renal Disease (
abnormal backflow of urine from bladder into the ureters and kidneys; bladder never fully drains, get urinary stasus
vesicoureteral reflux
80% of MG is associated with tumor or hyperplasia of
thymus gland
progressive irreversible deterioration in renal function, resulting in uremia
chronic renal failure
Meningitis Dx
Lumbar Puncture (cloudy with bacterial; increased WBCs and PRO, decreased glucose, increased CSF pressure)
Spina Bifida Cystica
Meningocele (fluid-filled sac outside body with no nerves) OR Myelomeningocele (fluid-filled sac outside body that contains nerves)
seizures that involve both hemispheres; loss of consciousness, no memory of event
generalized seizure
seizures that involve one location in brain
partial seizure
melena, bruising, hematemesis, epistaxis can result from cirrhosis because
decreased production of clotting factors and prothrombin
viruses associated with GBS
EBV, mono, HIV, Hepatits
s/s MS
Early sign: weakness and fatigue in legs Flexor spasms at night intention tremor dysmetria blurred vision, nystagmus paresthesias, pain incontinence dysphagia, dysarthria cognitive changes progresses to quadriplegia
main electrolytes altered in kidney failure
increased potassium and phosphorus decreased sodium and calcium
Nsg considerations with IICP (4)
Airway: may hyperventilate or need suction, vent Temperature control Seizure precautions watch for urinary retention, promote bowel function
stroke cause by an embolus traveling from aother pairt of the body into a cerebral artery; more instant onset of s/s than thrombotic
Embolic stroke (Ischemic-type)
advantages of PD over HD
no vascular access needed freedom less diet and fluid restrictions bettwe BP control less CV problems
Stage of CRF in which kidneys cannot regulate volume and solute concentrations, resulting in: overt uremia with s/s decreased UO metabolic acidosis Edema
Renal failure
progressive autoimmune disease cause severe muscle weakness that improves with rest; antibodies destroy ACh receptors at NMJ; especially eye, facial, laryngeal, and respiratory muscles
Myasthenia Gravis
pancreatitis attack can be triggered by
large intake of alcohol and/or fat
sudden decrease in blood flow to a localized area of the brain; 3rd COD in US
Stroke
progressive neurodegenerative disease due to the degeneration and demyelination of upper and lower motor neurons, resulting in weakness and muscle wasting without sensory or cognitive changes
Amyotrophic Lateral Sclerosis (ALS)
Major CMs of CRF
Uremia Anemia FVE Hyperkalemia (and other electrolyte imbalances)
generalized seizure with rhythmic and repetitive muscle contractions, quick return to baseline
Clonic seizure
seizure first aid
lower to floor on side, align head with body remove harmful objects, loosen clothing stay with them, dont restrain don’t put anything in mouth ABCs
normal GFR GFR indicative of kidney dysfunction
normal=85-105 mL/min
new drug to slow degeneration of motor neurons in ALS
Riluzole
Problems associated with myelomeningocele
Brainstem abnormalities (decreased RR, dysphagia, laryngeal spasm) Scoliosis and Kyphosis (impedes pulmonary function) Neurogenic bladder (r/t UTIs, straight cath or stoma, often prev abx)
most common precipitating factors of autonomic dysreflexia
distended bladder or rectum
if HCW exposed to hepatitis
give vaccine, IVIG
pancreatitis management
pain relief rest pancrease–NPO, ng, TPN; bland diet when resume eating, no caffeine or EtoH BG control pancreatic enzymes
potential sequelae of bacterial meningitis
brain damage hearing loss limb amputation learning disabilities
manifestations of post-concussion syndrome (can last up to a year)
personality changes decreased attention span, concentration, and short term memory
complications of AV fistula/graft
stenosis infection thrombosis
s/s Myasthenic crisis
Increased HR, RR, and BP respiratory distress, oropharyngeal weakness incontinence
Left CVA characterized by
aphasia agnosia (difficulty recognizing objects) alexia and agraphia Right extremity hemiparesis (weakness) or hemiplegia (paralysis) slow cautious behavior, anger and frustration, depression; decreased memory hemianopsia (loss of visual field)
dangers if pancreatitis progresses (7)
Hemorrhage, shock Hypocalcemia-Tetany, spasms, paresthesias, cardiac dysrhythmias Paralytic ileus F&E imbalances/Hypovolemia due to ascites 3rd spacing (loss of protein rich fluid from autodigestion) Infection-pseudocyst of abcess due to fluid leakage Left lung effusion/atelectasis Coagulopathy/DIC
generalized seizure; body stiffens with short cry, can be apnea, incontinence, eye deviation; followed by rhythmic jerking that slows to limpness; can be confused or unarousable after
Tonic Clonic seizure (Gran Mal)
cirrhosis complications
Esophageal Varices (portal HTN increases pressure in veins, fragile collaterals develop; r/f hemorrhage) Hepatic Encephalopathy (asterixis, fetor hepaticus)
s/s Skull Fx
periorbital edema and bruising rhinorrhea and/or otorrhea (check for glucose, CSF leak) post-auricular ecchymosis
neuro checks in infants
behavior changes pupils reflexes
RFs for cirrhosis
*alcohol abuse *chronic viral hepatitis chronic biliary obstruction
post of VP/VA shunt placement, monitor
head circumference
surgical correction of hypospadias usually done at this age
6-18 mos
How to tell meningocele and myelomeningocele apart
Tranillumination (meningocele will tranilluminate, MMC won’t)
sudden, time-limited events caused by excessive disorderly discharge of cortical neurons
seizures
s/s HUS
*Bloody diarrhea gastroenteritis, n/v/d listless, pale, irritable bruising, anemia, TCP renal failure Triad: anemia + TCP + renal failure
HoTN can occur after HD due to
excess fluid removal
s/s epi/sub dural hematoma
restlessness, agitation then confusion and coma caused by brain compression due to bleed
kidney dysfunction increases r/f anemia and bruising because
the production of EPO is decreased
impaired blood flow leads to hypoperfusion of kidneys; restoring blood flow will stop damage
Pre-renal ARF
bladder is adult sized by
1 year
this condition occurs immediately after SCI causing flaccid paralysis and loss of reflexes below site of injury; can cause paralytic ileus
Spinal Shock
Clonic or Tonic Clonic simple or complex seizure associated with acute illness and fever of >102.2
Febrile seizure
when the flow of bile to the intestine is obstructed
increased bilirubin in blood dark urine stool changes
most common cause of acute liver failure and s/s
drug-induced hepatitis fever and chills rash, pruritis arthralgia a/n/v later: jaundice, hepatomegaly, dark urine
very brief generalized seizure of a shock-like jerk
Myoclonic seizure
s/s of acute pancreatitis
acute onset of severe, constant knife-like pain in LUQ, mid epi or upper back, unrelieved by vomiting, worse when lying down or eating n/v abd distention, decreased peristalsis, guarding Turner’s sign: flank ecchymosis due to seepage of blood-tinged fluid into SubQ tissues Cullen’s sign: bluish periumbilical discoloration
Stage of CRF in which s/s begin to appear: difficulty concentrating, azotemia, anemia, HTN
Renal insufficiency
VUR can stop growth of the kidney if it causes
hydronephrosis
HUS treatment
short-term dialysis, FFP, blood transfusions most kids recover without permanent damage
CMs of Bell’s Palsy
flaccidity of affected side of face pain around ear fever tinnitus, hearing defecit excessive tearing, eye can’t close properly
brief generalized seizure of extensor muscles, body stiffens and then returns to baseline
Tonic seizure
nephrotic syndrome vs AGN
AGN has HTN, NS normal or low bp severe proteinuria in NS, mild in AGN
may be first sign of DVT secondary to SCI
low grade fever
Intrinsic ARF
caused by damage to kidney tissue
Tensilon test used to Dx
MG Muscle tone improves within 1 minute of Tensilon–+ for MG
amount of impairment in spina bifida depends on AND types of impairments
level of spinal injury decreased sensation, paralysis, incontinence, joint deformities, dev delays, hydrocephalus
active inflammation in gomeruli, often following a streptococcal or pneumococcal infection; Immune complex hypersensitivity reaction in which antigen-antibody complexes become trapped in glomerular basement membrane causing swelling and occlusion
Acute Glomerulonephritis (AGN)
most common permanent disability in children; nonprogressive impairment of muscle control and coordination
Cerebral Palsy
these meds are used to treat trigeminal neuralgia
antiseizure meds (often used to treat neuropathic pain because they decrease transmission of nerve impulses)
causes of epi/sub dural hematoma
trauma aneurysm rupture anticoagulants bleeding disorder
4 types of jaundice
1) Hemolytic: destruction of RBCs increases bilirubin 2) Hepatocellular: liver can’t clear normal amounts of bilirubin 3) Obstructive: due to a stone 4) Hereditary hyperbilirubinemia
RFs for pancreatic cancer
Smoking high fat/meat diet chronic pancreatitis DM Hep C
acute gb inflammation that can occur without obstruction after surgery, trauma, other
acalculous cholecysitits
Hydrocephalus s/s in infants
increased head circumference vomiting (d/t IICP) lethargy, irritability sunsetting (downward deviation of eyes) seizures
treatment for patients too unstable for HD; does not produce rapid fluid shifts
CRRT-continuous renal replacement therapy
inflammation of the kidney that can result in renal scarring and loss of glomeruli, and can progress into Gm- septic shock
Pyelonephritis
advantages of HD over PD
rapid and better fluid removal less PRO loss q quick decrease in serum TGIs, urea and creatinine
HUS Patho
bacterial toxins cause glomeruli to become swollen and occluded with platelets and fibrin (intravascular coagulation); RBCs are damaged as they move through glomeruli and are then removed by spleen; child becomes thrombocytopenic
main assessment during PD dwell
respiratory status
CMs of Neurogenic shock
decreased BP, HR, CO blood pools in extremities no sweating–watch for sudden onset of fever bc they are unable to regulate temperature.
Crisis due to overmedication with cholinesterase inhibitors
Cholinergic crisis (too much ACh) improves with anticholinergic meds (atropine)
two main causes of CRF
DM and HTN increase pressure on kidneys until they get exhausted
Complications of AGN
reanl failure, sepsis *Hypertensive encephalopathy (HA, vision loss, photophobia, hemoparesis, disorientation, seizures) Pulmonary congestion
s/s Cholinergic crisis
decreased HR and BP muscle twitching, hypersecretions n/v/d, hypermotility (abd cramps) respiratory distress
post nephrectomy assess for
intestinal obstruction due to adynamic ileus: abd distention, decreased bowel sounds, vomiting
distinguishing features of ALS
spasticity and paralysis
causes of intrinsic ARF
most often ATN caused by ischemia (post-op, sepsis, burns, trauma) or nephrotoxins (poisons/OD, AG abx, NSAIDS, contrast media)
earliest sign of neuro decline
change in level of consciousness
Stage of CRF with atrophy and fibrosis in glomeruli, dialysis or transplant needed for survival
ESRD
with meningitis patients, monitor for
IICP (decreased HR, increased BP/widening pulse pressure, change in RR) Shock
Four primary s/s of Parkinson’s disease
Gradual insidious onset of: 1. Resting Tremor (“pill rolling”) 2. Muscle rigidity (jerky movement) 3. Bradykinesia (blank face, slurred slow speech, difficulty initiating movement, requires thought) 4. Postural instability (forward tilt; short shuffling gait)
s/s renal failure
confusion, lethargy decreased UO Fluid Volume Overload: crackles, edema anemia, bruising metabolic acidosis bone demineralization, calcification of BVs (decreased Ca and increased Phos)
s/s of Nephrotic syndrome
decreased UO; dark frothy urine high proteinurea hyperlipidemia hypoalbuminemia Edema-periorbital, facial, dependent) with a large weight gain Skin breakdown and Muerckhe bands
predialysis assesments
neuro status VS condition of vascular access site (thrill, bruit) weight (before and after)
Type of CP with hypertonicity and poor motor control and posture, impaired fine and gross motor skills
Spastic CP
Pre op for repair of spina bifida (close lesion within 6-12 hours of birth)
sterile moist soaks to protect sac keep prone
mild form of spina bifida in which the SC remains inside the body but the column is formed inccorectly; could have a hairy patch or dimple at base of spine
Spina Bifida Occulta
brief episode of neuro defecits (
Transient Ischemic Attack (TIA)
s/s pancreatic cancer
midabdominal pain unrelieved by position changes, more severe at night jaundice, hepatomegaly clay-colored stool dark urine ascites
normal creatinine and increased BUN indicates
dehydration
Parkinson’s Tx
correct NT imbalance with dopaminergics
increased lab values in acute pancreatitis
serum amylase, lipase; wbcs bilirubin and LFTs if caused by liver dysfunction
s/s of IICP
Early: decreased LOC, GCS; HA Cushing’s triad: widening pulse pressure, decreased HR, decreased RR altered resp pattern, increased effort pupil changes, slow reaction Late s/s: Posturing, rigidity; seizures Cheyne Stokes/Ataxic breathing projectile vomiting loss of brainstem reflexes
stroke Dx
CT for size, location, ischemic vs hemorrhagic
increased permeability of glomerular basement membrane allows protein to pass though into urine
Nephrotic Syndrome
BP tends to be unstable (low side) in SCI injuries above
T7
increased r/f this allergy with spina bifida
latex
epidural hematoma
arterial bleeding into epidural space; faster bleed than subdural
Treatment of nephrotic syndrome
Prednisone to stop protein leakage Diuretics Albumin
often first sign of UTI in an infant
poor feeding, irritability +fever and no URI or OM, check for UTI
ARF Nsg treatment : HDTV
Hyperkalemia: Kayexelate, monitor K Dilate renal arteries: dopamine Total Volume: cautious fluid admin to avoid dehydration (bolus NS) Volume control: Diuretics also: temporary dialysis may be needed
Oliguric Phase of AKI
Increased serum concentrations of metabolites and wastes (increased BUN/creat, increased urine SG and K Decreased UO (
Overactivity of autonomic NS that can occur after SCI above T5; causes acute uncontrolled HTN, bradycardia, HA
autonomic dysreflexia
most definitive dx for pancreatic cancer
ERCP
seizure with sudden and complete loss of muscle tone, momentary loss of consciousness; r/f injury
Atonic seizure
causes of pre-renal ARF
HoTN, HoVol (shock, trauma, dehydration) decreased CO (HF, MI)
progressive neurodegenerative disease involving degeneration of dopamine-producing neurons; balance between dopamine (inhibits muscles) and ACh (excites muscles) disrupted, ACh dominates making smooth, controlled movements difficult
Parkinson’s disease
cholelithiasis RFs
female, BCPs, obesity, multiple births
RFs for CP
*low birth weight premature/inadequate placenta/multiple birth RH or ABO incompatibility maternal infection
fatal form of hepatitis that quickly leads to hepatic encephalopathy and death
fulminating hepatitis
chronic pancreatitis patho
progressive and destructive, calcification and necrosis of pancrease, can lead to hemorrhage
Causes of microcephaly
genetic abn that impedes cerebral growth in early fetal development maternal drug/alcohol abuse during pregnancy maternal infection (CMV, rubella, varicella) or toxin exposure
