Chapter 18 MusculoSkeletal Diseases Flashcards
0
Q
Risk factors for osteoarthritis include
A
Advancing age which is the strongest factor. Joint trauma, obesity, overuse, familial tendency
1
Q
This is caused by gradual loss of cartilage at a joint articulation, with resulting development of bony spurs and cysts at the joint margins.
A
Osteoarthritis, also known as degenerative joint disease.
2
Q
The joints most commonly affected by osteoarthritis are?
A
The hands, knees, hips, spine, and feet.
3
Q
This is the most common symptom which is stiffening of the joint after prolonged inactivity and is called?
A
Gel phenomenon. The stiffness quickly subsides with movement, usually within 5 to 30 minutes. As further joint deterioration occurs, pain and aching become the predominant symptoms.
4
Q
As osteoarthritis progresses a grating or creaking noise can be noted with range of motion and this is called?
A
Crepitus
5
Q
Patients with osteoarthritis must be educated about what?
A
The importance of pain control to maintain a steady level of activity. Decreases in activity can lead to muscle atrophy and further loss of functional ability. In addition patients who are deconditioned have a higher risk of fall which can lead to further pain and disability.
6
Q
This is a reduction in bone mass and strength.
A
Osteoporosis
7
Q
Adults reach peak bone mass at about age what?
A
30
8
Q
The cycle of bone remodeling takes about how many months?
A
Four months
9
Q
What is important in the regulation of normal bone remodeling?
A
Sex hormones
10
Q
At what age for men and women do these sex hormones begin to decrease that assist with bone remodeling?
A
Menopause in women and about age 80 in men
11
Q
This proceeds osteoporosis and is a bone mineral density loss that is from one standard deviation up to 2.4 standard deviations below normal.
A
Osteopenia
The patient with a BMD the that reveals greater than 2.5 standard deviations below normal has osteoporosis.
12
Q
This type of osteoporosis is the most common and is related to factors involving the bone itself.
A
Primary osteoporosis
13
Q
This type of osteoporosis is found in which another medical condition is causing the osteoporosis.
A
Secondary osteoporosis
14
Q
Primary osteoporosis is divided into type one and type two. This one occurs in both genders age 70 or older as total bone production begins to wane. Cortical bone, which provides strength to the skeleton is lost. Hip fractures are common manifestation.
A
Type two osteoporosis
15
Q
This type of osteoporosis is related to estrogen deficiency and is seen in women ages 51 to 75. In this type that trabecular bone in the vertebrae, hips, and wrist become week.
A
Type one osteoporosis
16
Q
Some common medical conditions that cause secondary osteoporosis are?
A
Parathyroid disease, Cushing’s disease, hypogonadism, alcohol abuse, liver disease, hyperthyroidism, etc.
17
Q
Risk factors for osteoporosis include?
A
Female gender, increased age, white race, thin body frame, alcohol use, cigarette smoking, excess caffeine, and a diet low in calcium.
18
Q
Bone mass density should be assessed at least once in all women after age what? And for what age men?
A
65 for women and age 70 for men
19
Q
Nurses should suggest Patients discuss DEXA scan with their primary care providers if any of the following are present.
A
History of a fracture in a patient age 40 or older, family history, cigarette smoker, low BMI, dorsal kyphosis, loss of height
20
Q
The goal of treatment for osteoporosis is?
A
To increase bone mass density to prevent hip fracture. For each SD decrement in bone mass density, hip fracture risk increases about twofold.
21
Q
Management Of osteoporosis includes a diet rich in?
A
Calcium and vitamin D.
22
Q
Patients with osteoporosis should be encouraged to?
A
Quit smoking, drink only in moderation, try to prevent falls. Patients taking PPI such as protonic Nexium and Prilosec should take calcium citrate, which is more easily absorbed in the presence of these agents. Weight-bearing exercise such as walking or low impact aerobics and vigorous water Exercise.
23
Q
This medication was commonly used for the prevention of osteoporosis in women, although, with a high risk of thromboembolic events and breast-cancer it is less often used. contraindicated in patients with a history of CAD,thromboembolic the start of any type and breast-cancer.
A
Estrogen
24
This anti-resorptive medication given for osteoporosis can be associated with atypical femoral fracture with prolonged use. Use with caution in patients with dental or G.I. problems. It works well for both men and women. Can be given daily, weekly or monthly or every three months. Consider stopping after five years.
Biphosphonate (Fosamax, boniva, reclast and actonel) reclast Is contraindicated in patients with present or past history of atrial fibrillation
25
This anti-resorptive drug for osteoporosis works on the estrogen receptor, it can be used in patients with a history of breast cancer. It is contraindicated in patients with a history of thromboembolic disease.
Evista
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This antiresorptive drug comes in a nasal spray that can be used for osteoporosis of the spine.
Calcitonin or miacalcin
27
This drug for osteoporosis is a rank-ligand inhibitor that stimulates bone growth and decreases bone reabsorption. It comes in an injection form. Prolonged use maybe associated with spontaneous bone fracture and delayed bone healing. Not effective at preventing fractures with multiple myeloma.
Prolix
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Stimulates bone growth in individuals both men and women at high risk for fracture because of severe disease. Daily sub Q injections for two years, then followed with biophosphonate therapy. Countraindicated in people with history of radiation to the skeleton.
Parathyroid hormone (forteo)
29
This drug decreases urinary excretion of calcium thus slowing bone loss. It can be used in patients with concomitant hypertension
Hydrochlorothiazide (maxide, dyazide)
30
Nursing assessment To determine risk of osteoporosis includes?
Health history, Family history of osteoporosis, and presence of risk factors such as level of exercise, alcohol, caffeine, and smoking. Ask women about previous fractures, menopause, date of last mammogram, and history of gynecological cancer. Assess for kyphosis, gait impairments, and muscle weakness.
31
Nursing management of patients with osteoporosis include?
Control the pain, relaxation and repositioning techniques, education about the disease, prevention of falls, injuries, and other deformities, stressing importance of smoking cessation and decreasing alcohol, limiting caffeine, and recommending exercise at least every other day for 25 to 30 minutes.
32
This instrument developed by the World Health Organization can determine the ten year probability of hip, spine, forearm or shoulder fracture on the basis of bone density readings. It helps determine patients who would benefit from aggressive treatment of their osteopenia or osteoporosis.
FRAX
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Is a metabolic disease characterized by formation of spongy bone due to an adequate and delayed mineralization.
Osteomalacia
34
When the thyroid gland is not producing enough thyroxine it is known as?
Hypothyroidism
35
When the problem with the thyroid gland not producing enough thyroxine occurs at the level of the gland it self it is known as?
Primary hypothyroidism.
36
If the decrease in hormone function of the thyroid gland occurs because of a problem in the anterior pituitary it is known as?
Secondary hypothyroidism
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If the problem of decreased production of hormones by the thyroid gland is caused by the hypothalamus this is called?
Tertiary Hypothyroidism
38
The most common cause of hypothyroidism in older adults is?
Autoimmune thyroiditis.
39
Thyroiditis can be brought on by?
Virus, stress, or treatment of certain illnesses, such as Hodgkin's disease. Previous radiation to the head and neck can render the thyroid nonfunctional, as can oblation of the gland with radioactive iodine or surgery
40
On occasion, hypothyroidism can be the result of ingesting what?
Lithium, amiodarone, iodine, and kelp
41
The prevalence of hypothyroidism is higher or lower for women?
Higher for women than in men.
42
Primary hypothyroidism is characterized by an Elevated level of what hormone and a subnormal serum level of what?
An elevated level of thyroid stimulating hormone otherwise known as TSH, and a subnormal serum free thyroxine T4 level.
43
Common presenting signs and symptoms of primary hypothyroidism are?
Anorexia, weight loss, unstable gait or balance, arthralgias, muscle aches, weakness, unexplained lipid abnormalities, constipation, depressed affect, mild cognitive impairment. In older adults it's insidious onset of symptoms are often attributed to getting old.
44
hypothyroidism in older adults may manifest more serious signs and symptoms than younger adults such as?
Bradycardia, angina, cold intolerance, syncope, muscle cramps, and numbness.
45
Treatment of hypothyroidism includes replacement of the hormone level thyroxine. Depending on the elevation level of the TSH, the starting dose is usually what?, then on the basis of TSH levels which are checked every eight weeks, the doses titrated up until the TSH is At what level?
25-50mcg/day
| TSH of 0.3-3 mlU/L
46
Nursing assessment for patients with hypothyroidism should include?
Onset and pattern of fatigue, any history of weight or bowel changes, Depression scale, mental status exam,
47
Nursing management of patients with hypothyroidism include?
Education about the disease process, symptoms, and diagnostic testing that may be needed. Nurses should stress the importance of lifelong therapy and monitoring.
48
This is excessive secretion of thyroid hormones.
Hyperthyroidism.
49
This excessive secretion of thyroid hormone is usually associated with an enlarged gland (otherwise known as goiter). In older patients the most common cause is multinodular goiter rather than Graves' disease which is seen in younger adults.
Hyperthyroidism
50
Iodine induced hyperthyroidism can be seen with the use of what?
Amiodarone, which is 70% iodine and deposits iodine in the peripheral tissues.
51
What is commonly seen in the patient with hyperthyroidism as far as their TSH levels and levels of elevated free T4 and T3?
Suppressed TSH and an elevated free T4 and T3
52
Signs and symptoms of hyperthyroidism include?
Insomnia, increased tremor, bowel movements, weakness, hair loss, heat intolerance, tachycardia, weight-loss, and fatigue. 60% of older adults present with this type for thyroidism. AF Is the most common presentation of hyperthyroidism.
53
Medical management for hyperthyroidism includes?
Radioactive iodine. This therapy is curative and easily tolerated. Beta adrenergic blocker such as propranolol to control the symptoms of palpitations, tachycardia, and heat intolerance. After ablation patients must be monitored closely for signs and symptoms of hypothyroidism or worsened illness.
54
assessment for patients with hyperthyroidism include?
Assessment of weight loss, and BMI, fatigue, and cardiac symptoms. Other Comorbid states and medications should be noted.
55
Nursing management of patients with hyperthyroidism include?
education about the illness, diagnostics, and treatment. Many patients will require anti-thyroid medications: propylthiouracil or Tapazole, Before radioactive therapy. Nurses inform patients of the importance of taking these medications prior to Radioactive iodine therapy. Alert patients to potential for Exopthlamus(eye).
56
A person is considered prediabetic when their fasting blood glucose levels are between what?
100-126mg/dL
57
This term is used for a cluster of signs that are known to be associated with the risk of developing diabetes and cardiovascular disease.
Metabolic syndrome
58
These are the risk factors that lead to the development of metabolic syndrome
Obesity, sedentary Lifestyle, genetic predisposition, age, and poor dietary habits
59
The American Heart Association defined the criteria for diagnosis of metabolic syndrome to include three of the five factors for its diagnosis.
Elevated blood pressure >130 syst, >85 diastolic
Fasting blood glucose >100
Low HDL 40 in men, >35 in women.
Elevated Triglycerides >150 mg/dL or drug tx for
60
Management of patients with metabolic syndrome include?
Weight loss, exercise, and dietary modifications. Patient should be encouraged to start with 5 to 10% loss of their initial weight by decreasing their daily caloric intake by 500 cal per day and begin to increase their physical activity by 10 to 15 minutes per day. A food log may be helpful for the patient. Diabetes s&sx.
61
In this type of diabetes, the insulin secreting ability of the pancreas is absent or near absent.
Diabetes type one disease.
62
In this type of diabetes patients may have problems with insulin secretion, but they can still produce insulin in normal or supranormal levels. These patients are often obese, a state that is associated with high levels of native insulin production, which may alter the number or function of the insulin receptors on the cell wall.
Type two diabetes
63
In this type of diabetes Glucose cannot enter the cell, and excess insulin is produced to compensate for this problem rendering a patient hyperinsulinemic. Some patients with this type of diabetes may have defects in their insulin receptors that cause insulin to transport glucose ineffectively into cells.
Type two diabetes
64
Signs and symptoms of diabetes include?
Polydipsia, polyuria, or polyphagia. Older patients may present atypically with fatigue, blurred vision, infection, or change in weight.
65
Symptoms of diabetes, in an older diabetics include?
Infection of the foot or cellulitis of the leg, vaginitis, urinary tract infections, impotence, numbness of fingers or toes.
66
Nursing assessment for patients with diabetes include?
Review of medical history, medications, family history of diabetes, current medications patient is taking, glucose monitoring if the patient is already diagnosed, history of high or low blood sugars or any self-care restrictions that could interfere with managing diabetes.
67
Patients who are already diagnosed with diabetes should be assessed for what?
Patients readiness and ability to learn, past and present blood glucose readings should be reviewed. Review neurological sequelae of diabetes such as numbness, tingling, blurred vision, headaches, and inability to feel temperature.
68
What should the physical exam of a patient with diabetes include?
Skin, specifically legs and feet. Document skin turgor, dryness, peeling, lesions, pedal pulses, and presence or absence of hair growth on the lower extremities.
69
Nursing management for diabetic patient includes?
Diet and medication counseling, emergency identification, instructions for monitoring, exercise, lifestyle changes, sick day management, skin changes, and wound infections, consider referral to certified diabetes educator.
70
General diabetes education includes?
Pathophysiology of the disease, why it is important to monitor glucose and urine ketones, etiology and manifestations of hypo and hyperglycemia, foot & eyecare, complications, and supplies.
71
This diabetes medication works by decreasing hepatic glucose production increasing skeletal muscle uptake of glucose. Patients must have adequate renal function to use this. Not FDA approved for individuals age 80 or older.
Biguanides: metformin/fortamet.
72
This diabetes medication increases the amount of enzymes naturally occurring in the body to lower blood sugar. It can lower HB A1c by 0.5% to 1%. Maybe monotherapy or in combination with Metformin or thiazolidonedione.
Enzyme Inhibitors such as: januvia, onglyza.
73
This medication decreases hepatic glucose production and increases skeletal muscle uptake of glucose. It also increases the efficiency and number of glucose receptors on the cell membrane. It is contraindicated in stage III and stage IV heart failure. It can cause fluid retention.
Thiazolidonedione: rosiglitazone.
74
This medication for diabetes increases insulin secretion. It can cause hypoglycemia and weight gain.
Sulfonylureas: Glipizide & glimepiride
75
This diabetes medication increases insulin secretion, but only for a limited time after each dose ingested which is taken with each meal. It can cause hypoglycemia and weight gain.
Secretagogues: Nateglinide & Repaglinide
76
This diabetes medication can cause abdominal bloating increased gas, must Titrate dose up slowly.
Alpha-glucosidase Inhibitors: Acarbose & Miglitol
77
This diabetes medication increases insulin secretion and should be taken 30 minutes before meals.
Meglitinides: Starlix, Prandin
78
This diabetes medication works by stimulating the pancreas to secrete more insulin. It is an injectable agent. It is associated with risk of acute pancreatitis and possibly medullary thyroid cancer.
Byetta & Victoza
79
Examples of rapid acting insulin include?
Humalog, novolog, apidra, Dosage decrease may be needed with renal dysfunction.
80
Examples of regular insulin whose onset is 1 to 3 hours are?
Humulin and novolin
81
Examples of intermediate or long acting insulin's
NPH- Humulin and novolin 1-12 h
Detemir / Levemir 6-8h
Glargine/lantus 2-24 h
Isophane & regular premixed novolin 70/30 30min- 12h
82
Patients with diabetes should wear what?
Emergency identification medic alert bracelets or necklaces.
83
What are some important things to teach diabetic patients about exercise?
Exercise helps reduce insulin resistance and hyperglycemia. Patient should check their blood sugar before exercising and carry a source of carbohydrates in the event of low blood sugar. Patient should not exercise at their blood sugar is greater than 250 mg a deciliter. Exercise can worsen high blood sugar.
84
If the patient should become ill who is diabetic they should have what kind of plan?
Sick day plan. During these times patients may have quite elevated blood sugars and should have some guidelines on when to call the primary healthcare providers and when and how to adjust her medications if possible.
85
Diabetic should be taught what about footcare?
Patients with diabetes may lose the ability to sweat, which can accentuate any potential foot problems. Patient should be taught the importance of daily diabetic foot exams and how to properly cleanse and dry their feet. They may develop dryness, cracking, and seizures on the plantar aspect of the feet.
86
This is a term used to describe the vascular neurological changes that can be seen in the lower extremities of the patients with diabetes. Decreased arterial flow and nerve damage from hyperglycemia contribute to this condition and can lead to amputation.
Diabetic foot syndrome.
87
This occurs when impaired circulation to the brain disrupts the supply of oxygen. The signs occur suddenly and last more than 24 hours and is a medical emergency.
Stroke or a cerebrovascular accident
88
This consists of the same symptoms of a stroke, but last less than 24 hours.
TIA Transient ischemic attack
89
What are the two types of stroke?
Hemorrhagic And ischemic
90
Short-term hypoxia of the brain causes the signs and symptoms of what? While prolonged hypoxia causes what?
Short-term hypoxia is associated with a TIA and prolonged hypoxia causes a CVA
91
Risk factors for stroke and TIA include?
Inflammatory artery disease, sickle cell anemia, hypertension, arterial sclerosis, emboli, previous heart surgery, smoking, hyperlipidemia, family history of strokes, thrombosis, substance-abuse, diabetes, atrial fibrillation, and head trauma.
92
Ischemic strokes can have one of three etiologies?
Thrombosis, cardioembolic, or small vessel intracerebral occlusion otherwise known as lacunae stroke.
93
Hemorrhagic strokes on the other hand are divided into two etiologies. What are they?
Subarachnoid and intracerebral. The most common causes uncontrolled hypertension.
94
Other causes of a hemorrhagic stroke besides hypertension include?
Intracerebral aneurysm rupture, arterial venous malformation, bleeding from a tumor, hemorrhage from anticoagulation or blood dyscrasia, head trauma, illicit drug use, specifically cocaine.
95
Some modifiable risk factors of stroke include?
Hypertension, diabetes, cardiovascular disease, atrial fibrillation, dyslipidemia, smoking, and obesity, Sedentary lifestyle, high stress level, alcohol use, illicit drug use, PFO, operable occlusion of an arterial vessel, abrupt cessation of antihypertensive regimen that precipitates hypertensive crisis.
96
Patients with a stroke with blurred vision, temporary loss of central vision in one eye (amaurosis fugax), paresthesias, or weakness what part of the circulation is involved?
The anterior circulation or internal carotid arteries.
97
If this part of the circulation is involved in a stroke the patient may have ataxi, diplopia, facial weakness, circumoral numbness, bilateral sensory abnormalities, or bilateral motor abnormalities.
Posterior circulation is involved or the vertebral/basilar artery
98
Early warning signs of a TIA that is thrombotic in nature includes?
Transient paresis, dysarthria or loss of speech, abnormal sensory changes, and paresthesias of one side of the body.
99
Signs and symptoms that can proceed a hemorrhagic stroke may include?
Headache, fainting paresthesias, epistaxis, dizziness, or retinal hemorrhage.
100
Medical management of a patient who presents in the ER with signs and symptoms of stroke include?
A noncontrast CT or MRI of the brain to determine if the stroke is hemorrhagic or thrombolytic. And EKG is done to assess for cardiac cause of the event.
101
Patients with a confirmed thrombolytic stroke who present to the ER before how many hours have lapsed may be given a thrombolytic agent Such as recombinant tissue plasminogen activator.
Three hours
102
Exclusion criteria for the use of recombinant tissue plasminogen activator's in thrombolytic stroke's include?
Current use of an anticoagulant, prothrombin time >15 seconds, heparin within the past 48 hours, platelet count of , BP >185/110.
103
If the patient is not a candidate for recombinant tissue plasminogen activator's then other medications such as what can be given?
Anticoagulants such as heparin, lovenox, antiplatelets such as aspirin and Plavix
104
For patients with stroke pressors are titrated to keep the blood pressure below what?
180/105 and hypertension is avoided. The labetalol and nitroprusside are often used
105
If the stroke was caused by subarachnoid hemorrhage what type of medication might be used to reduce blood pressure?
Calcium channel blockers such as nimodipine to decrease or prevent vasospasm of the vessels.
106
Some nursing interventions for patients who have suffered a stroke include
HOB at 30 to 45° to prevent an increase in intracranial pressure. Monitor vital signs closely, ROM exercises, repositioned every two hours, monitor for signs of DVT, resume and monitor dietary intake After swallowing evaluation has been done. Teach alternative methods of communication for patients with dysarthria
107
This is usually mild tremor of the head and upper extremities. The manifestations involved purposeful movements such as holding a cup of coffee or signing a check. The symptoms may be relieved with ingestion of a small amount of alcohol.
Essential tremor.
108
A common treatment for essential tremor includes?
Low doses of beta blockers such as propranolol, nadolol and Mysoline.
109
Essential tremors usually occur around what age?
They begin to manifest around the mid to late 40s.
110
This is a slowly progressive deterioration of the basal ganglia that destroys the dopamine pathways. It presents in patient as progressive slowness of movement, resting tremor, muscular rigidity and loss of postural reflexes
Parkinson's disease
111
Other diagnostic criteria for Parkinson's disease include?
Cogwheeling, slowness of movement, and impaired writing reflex after he sternal nudge..
112
This neuronal area located deep within the cerebellum controls muscle tone and smooth voluntary movements.
Basal ganglia
113
These two chemicals within your body control movements within the basal ganglia.
Acetylcholine and dopamine.
114
In Parkinson's disease the deterioration of what in the basal ganglia causes an imbalance between acetylcholine and dopamine?
The deterioration in the dopamine pathways cause a lack of dopamine in the basal ganglia
115
The imbalance between acetylcholine and dopamine causes the classic symptoms of Parkinson's such as?
Tremor, rigidity, slow movement (Bradkinesia) or lack of movement (Akinesia)
116
Risk factors for Parkinson's include?
Drug-induced, Toxin induced, exposure to certain herbicides pesticides, trauma to the midbrain, and stroke.
117
During the trajectory of Parkinson's disease, these patients also may develop the following manifestations.
Festination: Patient can take only small steps.
Freezing: Patient suddenly stop, as if frozen in place.
Propulsive gate: Patients walk flexed forward taking small steps and their gate gets progressively faster as if they're running. They may not be able to stop themselves until they fall. Retropulsion: may have the tendency to fall backwards
118
The autonomic nervous system is markedly affected by Parkinson disease. what might patient experience as a result of this?
Postural hypotension, excess perspiration of the face and neck, seborrhea on the face and neck, and heat intolerance, mood disturbances, sleep disturbances, dysphasia, and frequent falls, usually backwards.
119
What specific test can patient have to confirm diagnosis of Parkinson's disease?
There are no specific tests that can prove the diagnosis. For the most part the diagnosis is made in healthcare providers office and confirmed by the patient responding to anti- Parkinson medication.
120
Management of patients with Parkinson's include?
Relieving symptoms, improving functional status, and decreasing injury.
Patients will have to take more and more medications throughout the duration of illness to continue to be mobile.
121
This Parkinson's disease drug works by inhibiting monoamine oxidase type B from converting chemical byproducts into neurotoxins that can cause a cell death in the substantial nigra
Selegiline, rasagline
122
This antiparkinson drug works by stimulating the dopamine producing cells to work more effectively, thus increasing endogenous dopamine levels.
Dopamine agonist such as: Ropinirole(requip), Pramipexole (Mirapex)
123
This Parkinson drug supplies exogenous dopamine in an attempt to replace what is deficient.
Dopaminergic's: Amantadine (Symmetryl), Cardova levodopa (Sinemet).
124
This Parkinson drug prevents the peripheral degradation of dopamine before it enters the central nervous system, therefore increasing the amount of usable dopamine supply to the brain.
Catechol O-methyltransferase (COMT) Inhibitors: Tolcapone & entacapone
125
These two anticholinergic drugs are sometimes used for patients with Parkinson's. Monitor for delirium and other anticholinergic side effects such as dry mouth, dry eyes, and constipation.
Cogentin and Artane
126
Three categories of surgical therapies that can be used for patients with Parkinson's disease include?
Ablation,
deep brain stimulation, and
transplantation with fetal neural tissues: this idea is still in the experimental phase.
127
Nursing interventions and teaching strategies for patients with Parkinson's disease include?
The importance of exercise, use of assistive devices, and strategies to prevent injuries. Education should include the fact that PD is progressive and will require many medications over the duration of the illness.
128
The most common etiologies of dizziness and older adults include two?
Vertigo and orthostatic hypertension
129
Vertigo can be divided into two broad classes
Peripheral vertigo originates in the vestibular system of the inner ear. Central vertigo results from a disruption of blood flow to the cerebellum, which is the brain's balance center.
130
The most common cause of peripheral vertigo in older adults is?
Labyrinthitis, a recurrent vestibular syndrome and benign paroxysmal positional vertigo.
131
Labyrinthitis is caused by?
A viral infection or vascular injury to the labyrinth.
132
Labyrinthitis Presents with what symptoms?
Sudden onset of nausea, vomiting, and vertigo. If the auditory portion of the labyrinth is affected tinnitus and hearing loss also may occur.
133
This recurrent vestibular syndrome causes recurrent attacks of vertigo accompanied by tinnitis and hearing loss. Usually there is associated ear pain or fullness. This disease is treated with salt restrictions, diuretics, and discontinuation of caffeine and nicotine.
Meniere's disease
134
This is a syndrome that often follows an acute cause vertigo but usually resolves with time. It can also be migraine related.
Recurrent vestibulopathy
135
This type of vertigo is brought on by changes in head or body position and is caused by calcium particles that breakoff from the sacule or uticle migrate into the semicircular Canal.
BPPV Or Benign paroxysmal positional vertigo. Attacks usually last 1 to 2 weeks, but often recur months or years later.
136
Treatment for BPPV include?
Symptomatic treatment with meclizine is sometimes prescribed. Vestibular retraining exercises are useful to diminish symptoms.
137
The textbook definition of orthostatic hypertension requires?
20 mm Hg drop in systolic BP or a 10 mm Hg drop in diastolic pressure on standing. Many older adults do not meet the standard definition, yet still have significant symptoms. Often, a drop in blood pressure will not occur for several minutes after standing, and dizziness may affect older adults once they begin to walk.
138
True or false: a high-risk time for orthostatic hypotension is after eating.
True, circulation is shunted to the stomach and intestines to aid in the digestion of food.
139
Treatment for orthostatic hypertension includes?
Eliminating aggravating factors or reversible causes, increasing fluid and salt intake, elevating the HOB. Educate patients about standing up slowly and using support until dizziness passes. This is important after meals. Wearing compression stockings during the day is helpful.
140
If other measures fail to assist with orthostatic hypotension, the following medications may be used to raise blood pressure.
Florinef or Midodrine (proAmantine).
