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disorders Flashcards

1
Q

Cholinergic crisis

A

Cholinergic crisis is a clinical condition that develops as a result of overstimulation of nicotinic and muscarinic receptors at the neuromuscular junctions and synapses. This is usually secondary to the inactivation or inhibition of acetylcholinesterase (AChE), the enzyme responsible for the degradation of acetylcholine (ACh). Excessive accumulation of acetylcholine (ACh) at the neuromuscular junctions and synapses causes symptoms of both muscarinic and nicotinic toxicity. These include cramps, increased salivation, lacrimation, muscular weakness, paralysis, muscular fasciculation, diarrhea, and blurry vision[1][2][3].

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2
Q

may have aura or not. Familial, 4 phases: prodromal ( sleepiness, irritability, food cravings, etc.), aura- visual disturbance, difficulty speaking, numbness, headache- nausea and vomiting, and resolution-sluggishness or confusion.

A

Migraine

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3
Q

is described as throbbing, boring, viselike, pounding* one-sided

A

Migraine pain

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4
Q

Medications: NSAIDs (not aspirin), Vasoconstrictors, ergot, Triptans like sumatriptan, Opioids are last resort

A

Migraine-prophylactic or acute

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5
Q

Pain described as pressure, aching, steady, tight.

A

Tension/Muscle Contraction Headache

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6
Q

Throbbing, and excruciating. Unilateral affecting nose eye and forehead. Blood shot teary eye.

A

Cluster Headache

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7
Q

WHAT’S UP
assessment

A

W—Where is the pain? Does it radiate
H—How does the headache feel?
A—Aggravating or alleviating factors?
T—Timing: When does it typically occur? How long does it last?
S—Ask the patient to rate the severity.
U—Ask about other useful data.
P—Determine the patient’s perception of the headache.

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8
Q

Abnormal electrical discharges in the brain related to instability of neuronal cell membranes

A

Seizures

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9
Q

Genetic Predisposition
Acute febrile state
Head trauma
Cerebral edema
Abruptly discontinuing drugs
Infections
Metabolic disorders
Exposure to toxins
Stroke
Heart Disease
Brain tumor
Hypoxia
Acute substance withdrawal
Fluid and electrolyte imbalance

A

Risk Factors for Seizure Disorder

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10
Q

Not taking meds
Increased physical activities
Excessive stress
Hyperventilation
Overwhelming fatigue
Acute alcohol ingestion
Excessive caffeine intake
Exposure to flashing lights
Substances like cocaine, aerosols, inhaled glue products.

A

Triggering Factors

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11
Q

-repetitive, purposeless behaviors

A

Automatisms

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12
Q

Paresthesia

A
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13
Q

Remains conscious
Automatisms-repetitive, purposeless behaviors
Usually <1 minute
Paresthesia and visual disturbances, unusual sensation, hallucinations, flashing lights

A

Partial seizures

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14
Q

Possible aura
Repetitive acts, amnesia.
Can have paresthesia if from parietal lobe, visual disturbances if occipital lobe etc.
Can lose consciousness, 2 to 15 minutes.
Can maintain consciousness- but dreamlike state, picking at clothing, chewing, smacking lips.

A

Complex partial

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15
Q

Generalized seizures- entire brain
Absence (petit mal)- common in children
Staring, lip smacking-several seconds ( change in consciousness), absent motor, lasts seconds, returns to baseline neuro function post seizure
Tonic-<30 sec, lose consciousness
Clonic - last minutes , muscle contracts
**Tonic- Clonic ** or grand mal
May have aura, usually lose consciousness
Rigidity followed by muscle contraction and relaxation
Incontinence, & Postictal period

A

Generalized Seizures

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16
Q

30 minutes of continuous seizure activity without a return to consciousness.
Or a prolonged seizure lasting longer than 5 minutes.

A

Status Epilepticus

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17
Q

Abruptly stopping anti-seizure drugs
Substance withdrawal from AED
Head injury
Cerebral edema
Infection
Metabolic disturbances - DM

A

Causes of Status epilepticus

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18
Q

Traditional Drugs:
Phenytoin -gums, rash arrhythmias- 10-20 mcg/mL
Carbamazepine- anemia, rash, edema-6-12 mcg/mL
Valproic acid-lethargy, N&V, liver toxicity- 50-100 mcg/mL
Newer drugs:
Gabapentin, lamotrigine, topiramate, pregabalin, oxcarbazepine
Other drugs used: Benzodiazepines: diazepam and lorazepam

A

Common Seizure Medications

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19
Q

TBI

A

Traumatic Brain Injury

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20
Q

Concussion
Contusion
Diffuse axonal injury and
Intracranial hemorrhage

A

Types of TBI include:

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21
Q

Complications
Hemorrhage
Nerve root damage
Re-herniation- lumbar disks can re-herniate.
- Cervical disks are totally removed
Herniation of another disk- R/T fusion of the cervical spine. Must exercise to move spine

A

Herniated Disk Surgery

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22
Q

Types
Laminectomy- removal of the laminae ( flat piece of bone on each side of vertebra
Diskectomy-replacement of disk with bone.
Percutaneous diskectomy- needle aspiration of herniated tissue
Spinal fusion-bone graft to fuse 2 vertebrae together
Artificial disk- plastic

A

Herniated Disk Surgery

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23
Q

Spinal canal compresses the spinal cord.
Cause
Arthritis
Symptom
Pain and weakness
Hyperreflexia weakness of arms and legs ( if Cervical spine)
Treatment: **Laminectomy **and rehab

A

Spinal Stenosis

24
Q

Happens immediately following spinal cord injury.
Sympathetic nervous system disruption
Vasodilation
Hypotension
Bradycardia
Hypothermia
Urine and feces retention
Paralytic ileus
Flaccid paralysis

A

Spinal Shock

25
Q

Emergency management
Respiratory
Gastrointestinal
Genitourinary
Immobilization

A

Spinal Cord Injury

26
Q

Infection
Deep vein thrombosis
Orthostatic hypotension
Skin breakdown
Renal complication
Depression and substance abuse
Autonomic dysreflexia

A

Spinal Cord Complications

27
Q

Autonomic dysreflexia

A

This life-threatening complication occurs in patients with injuries above the T6 level. The spinal cord injury impairs the normal equilibrium between the sympathetic and parasympathetic divisions of the autonomic nervous system. If a noxious stimulus below the spinal cord injury causes activation of the sympathetic system, it will continue unchecked because the parasympathetic responses cannot descend past the spinal cord injury.

28
Q

The most common cause of autonomic dysreflexia is bladder distention. Other causes include bowel impaction, urinary tract infection, ingrown toenails, pressure injuries, pain, and labor in a pregnant woman. Stimulation of the sympathetic nervous system results in cool, pale skin, gooseflesh, and vasoconstriction below the level of the injury. Blood pressure can rise as high as 300 mm Hg systolic. The parasympathetic response results in vasodilation, causing flushing and diaphoresis above the lesion and bradycardia as low as 30 beats per minute. The patient reports a pounding headache and nasal congestion secondary to the dilated blood vessels.

A

Autonomic dysreflexia

29
Q

Surgical management
Stabilize spine
Halo brace
Rods
Corset
Brace
Body cast

A

Spinal Cord Injury

30
Q

A. Crutchfield tongs
B. Gardner-Wells tongs

A

Skeletal Tractions

31
Q

Nursing diagnoses
Impaired Gas Exchange
Ineffective Airway Clearance
Risk for Autonomic Dysreflexia
Reflex Urinary Incontinence
Constipation
Impaired Physical Mobility
Self-Care Deficit (Dressing/Feeding/Toileting/Bathing)
Risk For Impaired Skin Integrity
Ineffective Role Performance
Risk for Sexual Dysfunction
Anxiety

A

Spinal Cord Injury

32
Q

Etiology
Huntington disease
Parkinson disease
Alzheimer disease
Vascular dementia
Chronic alcoholism
Medications
Neurologic infection
Head injuries

A

Dementia

33
Q

Diagnostic tests
Neuropsychological testing
Depression testing
Medication review
M R I, C T scan, positron emission tomography (P E T) scan for underlying cause

A

Dementia

34
Q

Temporary mental disturbance with disorganized thinking and difficulty staying focused.
Medical emergency
Underlying cause must be corrected
Pain
Hypoxia
Medications
Illness

A

Delirium
medical emergency

35
Q

Destruction of substantia `nigra

Decreased dopamine production
Relative excess of acetylcholine
Impairment of semiautomatic movements

A

Parkinson Disease

36
Q

Diaphoresis
Constipation
Orthostatic hypotension
Drooling
Dysphagia
Seborrhea
Frequent urination

A

Symptoms of Autonomic Nervous System Dysfunction

37
Q

Pathophysiology
Infection/inflammation of brain and spinal cord
Purulent `exudate
Increased intracranial pressure
Possible cranial nerve involvement

A

meningitis

38
Q

Neisseria meningitidis
Streptococcus pneumoniae
Group B streptococcus
Haemophilus influenzae type B ( immunization)

A

Bacterial: very serious , spreads by direct contact from respiratory infections

39
Q

Signs and symptoms-
Severe headache
Fever
Photophobia
Petechial rash
Nuchal rigidity
Positive Kernig and Brudzinski signs
Nausea and vomiting cause by irritation of brain tissue
Encephalopathy

A

meningitis

40
Q

Is a temporary blockage of blood to the brain, causing a brief neurologic impairment.
Deprives brain of glucose and oxygen
Symptoms resolve quickly in minutes to hours.

A

Transient Ischemic Attack (TIA)

41
Q

Thrombotic: occlusion builds up in an artery until flow is decreased or blocked. Usually in the internal or common carotid arteries.

A

Ischemic stroke- most common cause

42
Q

Embolic Stroke is as a result of a blood clot often from the heart but can be from any where that gets trapped in a small vessel.
Usually found in cerebral arteries

A
43
Q

Subarachnoid
Intracerebral

A

Hemorrhagic stroke is caused by rupture of a cerebral blood vessel this blood cannot escape.

44
Q

a stroke that occurs on the surface of the brain, usually from an aneurysm.
Serious, can be fatal
Need surgical intervention

A

Subarachnoid hemorrhage

45
Q

a stroke in the deeper tissues of the brain.
This type is R/T HTN. Frequent hemorrhagic strokes adds up overtime.

A

Intracerebral hemorrhage

46
Q

Modifiable
Hypertension
Smoking
Diabetes mellitus
Cardiovascular disease
Atrial fibrillation
Carotid stenosis
T I A
Sickle cell anemia
Dyslipidemia
Obesity, inactivity
Pregnancy
Migraines
Oral contraceptives
Thick waist
Hormone replacement

Nonmodifiable
Age
Gender
Heredity
Prior stroke or heart attack

A
47
Q

Sudden numbness or weakness
Sudden confusion or trouble speaking
Sudden change in vision one or both eyes
Sudden trouble walking/dizziness
Sudden severe headache ( worst headache
CALL 911!

A

Warning Signs

48
Q

Nausea
Facial and limb pain
Sudden behavioral changes
Hallucinations
General weakness
Chest pains and palpitations
SOB
Hiccups

A

Warning signs for Women

49
Q

F.A.S.T.

A

Face: Smile ( is it drooping?)
Arms: Raise arms (does one arm drift downwards?)
Speech: Repeat a phrase ( Is it slurred)
Time – If yes to any then call 911

50
Q

Depend on area of brain affected
One-sided weakness/paralysis /numbness
Dysphagia
Sensory loss
Mental status changes
Visual disturbance: curtain dropping, fog
Speech/language disturbance: aphasia: receptive or expressive. Slurred speech is dysarthria

A

Acute Signs and Symptoms of stroke

51
Q

C T scan is done immediately 1st – to differentiate the type of stoke
Electrocardiogram checking for afib 2nd
Complete blood count, electrolytes, glucose
Metabolic panel
International normalized ratio/ prothrombin time 1.1 (2.0-3.0 is therapeutic on e.g. warfarin) and 10-12 seconds PT
National Institutes of Health Stroke Scale
Carotid Doppler & Cerebral angiogram

A

diagnostic test of stroke

51
Q
A
51
Q
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52
Q

seen in patients who had rt side brain stroke. They may be unaware of the side of the body that is affected and try to perform activities .

A

Unilateral Neglect

52
Q
A

Nervous (8 decks)

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