ATI Neuro/Musculoskeletal Flashcards
Gullian Barre
Greatest risk is adventitious breath sounds- sign of respiratory failure
Expected findings, not priority: altered sensory perception, loss of bowel and bladder control, weak or incomplete eye closure.
Increased ICP
restlessness, irritability, hypertension, widening pulse pressure
Stimulate micturation in spastic bladder
stroking the inner thigh
Acute angle closure glaucoma med
IV osmotic diuretics, emergency treatment to rapidly reduce intraocular pressure
Myasthenic crisis- increasing muscle weakness
administer tensilon test- this will determine if its a myasthenic or cholinergic crisis.
not priority- instill artificial tears for dry eye, administer immunosupressants and prep for plasmapeheresis to reduce symptoms
MS characterized by
remissions and exacerbations, unpredictable
Gullian Barre
respiratory failure, ascending paralysis
Amytrophic lateral sclerosis
respiratory failure, gradual loss of cognitive function
make sure to monitor pulse ox- greatest risk is resp compromise because progressive paralysis
not priority- bowel training, pain meds, adequate oral intake
Seizures
est IV access
dont need bed rest, dont put anything in mouth, dont need to assess for spike in BP, doesnt correlate with incidence of seizure
Carbidopa/Levidopa (SINEMET)
dont take with high protein food- delays absorption or reduce amount absorbed
- may feel lightheaded- orthostatic hypot
- urine, saliva, sweat will be darker
- weeks or months for symptom relief
Alzheimers drugs
may help delay cognitive changes. they enhance the availability of acetylcholine allowing for greater response from cholinergic neurons in the brain
phenytoin (Dilantin) for epilepsy
take med at same time each day to maintain therapeutic blood levels.
tell dr if you get rash.
still take med even in absence of seizures.
maintain good oral hygiene.
Right sided homonymous hemianoposia
loss of vision in right visual field of both eyes, may not be able to see half of meal tray- tell them to consciously look at both sides of meal tray.
total hip
use abductor pillow between clients legs if client becomes restless. pt should not adduct hips due to risk of dislocation. pillow will help hips remain in abduction.
dont flex hip more than 90 degrees.
wear thromboembolic hose.
Right hemispheric stroke
impulsive behavior, poor judgement, lack of awareness of neurological deficits. left sided deficits.
left hemispheric stroke
aphasia, right sided neglect, inability to read
alendronate (Fosamax)
take before breakfast in upright position for 30 minutes.this prevents esophagitis or esophageal ulcers. Biphosphonates are structural analogs of normal bone constituents, they are incorporated into the bone tissue to prevent bone resorption- may decrease serum calcium level.
Embolic cerebrovascular accident
tissue plasminogen activator (Alteplase)
closed head injury on vent
maintain paco2 of approximately 35 mmhg to prevent hypercarbia. vasodilation effects of carbon dioxide can lead to increase in ICP
pt in skeletal traction complains of muscle spasms
check position of weights and ropes- ensure weights are hanging freely- first action.
not first actions- reposition, notify pcp, muscle relaxant
after LP
ensure pt lays flat for 4-8 hours to prevent csf leakage from the puncture.
increase fluid intake to 3000 mL to facilitate csf production.
dont need pressure dressing.
shouldnt need pain med.
Detached retina
floating dark spots, flashes of bright light, usually painless
Cataract surgery- after
call dr if experience decreased vision.
dont take aspirin following surgery.
avoid activities that require bending over- can increase intraocular pressure.
dont need to sleep upright for 24 hours.
Rheumatoid arthritis
bilateral and symmetrical, ulnar deviation & deviation of fingers- inflammation in small joints makes them susceptible to deformity from daily use (opening jars etc).
Increased sedimentation rate r.t bodys response to inflammatory connective tissue disorder.
warm red joints.
Osteoarthritis
unilateral joint involvement, deformity of the spine
Crepitus with joint movement, decreased ROM of affected joint, joint pain that resolves with rest, larger joints- hips and knees.
Phantom limb pain
treat as real pain- gabapentin (Neurontin)
postop craniotomy
elevate HOB 30 degrees- keeps head in neutral position and promotes venous drainage. greatest risk is increased ICP.
not highest priority- administer corticosteroids, obtain ABGs, assess head drsg
Menieres disease, how to decrease symptoms
move head slowly to decrease vertigo
Quadriplegic, cervical fracture c5, reports throbbing, headache, nausea, facial flushing, increased BP
Elevate HOB- takes advantage of postural hypotension experienced by quadriplegic.
These findings are usually due to noxious stimul from lower parts of the body such as fecal impaction or distended bladder.
