Exam 1 Flashcards

1
Q

What type of disorders fall under the nervous system?

A

Seizures
Meningitis
Encephalitis
Parkinson’s
Multiple sclerosis
Migraine and cluster headaches
Cerebral vascular accident (CVA)/stroke

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2
Q

What is a seizure?

A

An abnormal electrical discharge in the brain. It interrupts normal brain function

Alters awareness, abnormal sensation, focal involuntary movements, or convulsions

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3
Q

What is epilepsy?

A

A chronic seizure disorder

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4
Q

What are the two different types of seizures?

A

Generalized
Partial

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5
Q

What is a generalized seizure?

A

Discharges occurs throughout the entire brain

Typically loss of consciousness

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6
Q

What is a partial seizure?

A

Only one half of the brain is affected.

Also called a focal seizure

Typically manifest as one structural abnormality

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7
Q

What are causes of seizures?

A

Genetics
Metabolic disorders
Mitochondrial diseases
Single gene mutation
Structural abnormalities (tumors, edema, increased ICP) ***brain stress

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8
Q

What are the phases of a seizure?

A

1) prodromal : mood or behavior starts to change (seizure may come in hours or days)

2) aura: premonition of impending seizure (visual, auditory, or gustatory)

3) ictal : seizure activity (usually musculoskeletal)

4) postictal : period of confusion / somnolence/ irritability that happens after the seizure

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9
Q

Manifestations of seizures

A

-aura
-short duration (1-2 minutes)
-postictal state
-Todd paralysis : in some people, one side of the body is weak and weakness last longer than the seizure
-Visual hallucinations
-Convulsions

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10
Q

How do you diagnose a seizure?

A

-head CT
-MRI
-EEG
-Lumbar puncture
-Electrolyte study
-Prolactin levels

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11
Q

What medications are used to manage seizure disorders?

A

Made medication is an anticonvulsant

Examples:
Levetiracetam (Keppra)
Carbamazepine
Oxcarbazepine
Lamotrigine
Phenytoin
Valproic
Fosphenytoin
Gabalentin

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12
Q

What are non-medication options to help manage seizure disorders

A

-Special diet (ketogenic/Atkins)
-Vagal nerve stimulation
-Implantable neurostimulator
-Lobectomy/lesionectomy
-activity modification/restrictions (driving, climbing, ladders, cooking, power tools/dangerous equipment, swimming, baths)

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13
Q

Nursing diagnoses (risks associated with) seizures

A

-Risk for trauma or suffocation
-Risk for an effective airway clearance
-Situational, low self-esteem
-Deficient knowledge
-Risk for injury

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14
Q

What history needs to be gathered during a nursing assessment for seizures

A

-Age they were at onset
-Frequency
-treatments they’ve had
-What are symptoms/manifestations are

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15
Q

What are nursing interventions for a seizure disorders?

A

-prevent injury
-Maintain airway
-educate patient and family (safety, triggers, compliance with meds)

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16
Q

What is meningitis?

A

Inflammation (swelling) of the protective membranes, covering the brain and spinal cord. Can lead to ICP

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17
Q

What are the causes of meningitis?

A

Usually caused by an infection:
Bacterial
Viral
Fungal
Parasitic
Amebic

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18
Q

What are the manifestations of meningitis?

A

Fever
Seizure
Neck stiffness
Positive Kernig’s sign
Positive brudzinski sign
Neurologic symptoms
Photalgia (photophobia)

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19
Q

What is Positive brudzinski sign?

A

Lift head up to put chin to chest, with involuntary flexing of hips and knees *a reaction to the stretch)

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20
Q

What is a positive Kernig’s sign?

A

(inability to extend knees more than 135 degrees)

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21
Q

What is the worst kind of meningitis?

A

Bacterial meningitis
Specifically; meningococcal

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22
Q

Where is Meningococcal meningitis commonly seen

A

Communal living situation
College dorm
Military barracks 

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23
Q

What are signs and symptoms of bacterial meningitis?

A

Fairly sudden onset of the following symptoms
Fever
Headache
Stiff neck
Rush

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24
Q

What are other possible signs of bacterial meningitis?

A

Nausea/vomiting
Sensitivity to light
Confusion
Drowsiness
Convulsions
Joint pain
Cold hands and feet
,coma

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25
How does bacterial meningitis manifest in children/infants?
Lethargy***** Poor eating Difficult to wake Sleepiness Crying when handled Irritability Grunting or difficulty breathing Bulging of the frontenelle High-pitched crying Convulsions Vomiting Pale or blotchy skin Abnormal reflexes Coma
26
What is different about viral meningitis?
-Can be caused by any virus -Not as severe as bacterial, and can often self resolve -It can cause lasting neurological deficits
27
How do you diagnose meningitis?
Lumbar puncture CBC Blood culture Head CT
28
How do you treat bacterial meningitis?
-Antibiotics -Control fever and pain -IVF (IV fluids) -Possible mechanical ventilation -Possible ICP monitoring
29
How do you treat viral meningitis?
-Antiviral medication -Control pain and fever -IVF -Possible mechanical ventilation
30
What are the main things that need to be assessed for meningitis?
-Neurological status -Pulse ox -Arterial blood gas
31
What are nursing diagnoses (risk of developing) for meningitis
-Infection -Acute pain -Impaired physical mobility -Activity intolerance -impaired skin integrity -injury -Interrupted family process -Anxiety
32
What are nursing considerations for treating a patient with meningitis?
-HOB elevated (semi Fowlers position) -Neurochecks -Pain assessment -Limit stimulation (dark, quiet room) -Manage nausea (vomiting, and increased ICP)
33
What is encephalitis?
Inflammation of cerebral tissue
34
What causes encephalitis?
Most commonly caused by the herpes virus
35
What are manifestations of encephalitis?
Fever Headache Nausea/vomiting Mental status changes Meningeal signs (stiff neck, photophobia) Seizures Motor deficit Personality changes Sign of brainstem involvement
36
What are signs of brain stem involvement?
Nystagmus (eye twitching) extraocular nerve palsies Hearing loss Dysphagia Respiratory dysfunction
37
What medications are used to treat encephalitis
Antivirals Anticonvulsants Steroids Pain management Sedatives
38
What is Parkinson’s disease?
A degenerative disease that is caused by depletion of dopamine
39
What does depletion of dopamine lied to my garden Parkinson’s?
-Dysfunction of the extrapyramidal system -slow, progressive disease, that results in a crippling disability -Can result in Falls, self-care, deficits, failure of body systems, depression
40
When does mental deterioration occur in Parkinson’s disease?
In the late stages
41
What are causes of Parkinson’s disease?
Hereditary Drug induced (dopamine, depleting drugs)
42
What are examples of dopamine depleting drugs?
Reserpine Phenothiazine Metocloprmide Tetrabenazine Droperidol Haloperidol
43
What are manifestations of Parkinson’s?
-Bradykinesia -Akinesia -monotonous speech -handwriting become smaller -Tremors -Pill rolling -Rigidity with jerky interrupted movements -restlessness and pacing -Mask (blank, facial expression) -Drooling -Difficulty swallowing and speaking -loss of coordination and balance -Shuffling steps, stooped position, propulsive gait
44
What are nursing diagnoses (risks of) Parkinson’s disease
-ineffective airway clearance -Disrupted thought process -impaired verbal communication -Impaired physical mobility -Imbalanced nutrition -Impaired swallowing -Risk for injury -Self-care deficit
45
How do you diagnose Parkinson’s?
Physical exam Levodopa challenge (put them on med and see if there’s an improvement) PET MRI
46
What are the medical/medication used to manage Parkinson’s disease?
Levodopa Neurosurgery Neurologic implants PT/OT
47
How can nurses help manage Parkinson’s disease?
-Assassin neurological status -Accessibility to chew and swallow -Diet -Increase fluid intake do 2000 ML per day -Monitor for constipation -Promote independence with safety measures -Do not rush patient -Assist with ambulation -Ambulation devices -Instruct patient to rock back-and-forth to initiate movement -Instruct the client to wear low heeled shoes -lift feet when walking -Firm mattress *** -promote proper posture with hands help behind back -Promote physical therapy and rehabilitation -Administer in monitor meds -Avoid foods high in B6 -Avoid monoamine oxidase inhibitors
48
What is the proper diet for someone with Parkinson’s disease?
High calorie High protein High-fiber Soft Small Frequent feedings NO B6
49
Why give a firm mattress to a patient with Parkinson’s?
Firm mattress with pt positioned in prone position without pillow to facilitate proper posture
50
What is multiple sclerosis?
Chronic, progressive, non-contagious, degenerative disease of the CNS Demyelinization of neurons
51
What is attacked during multiple sclerosis?
Myelin sheath around the nerves
52
What are the causes of multiple sclerosis?
Unknown Might be autoimmune
53
What are risk factors that can lead to multiple sclerosis
Pregnancy Fatigue Stress Infection Trauma
54
Manifestations of MS
-fatigue and weakness -ataxia (impaired balance or coordination) -vertigo -tremors -Blurred vision and diplopia (double vision) -nystagmus (dancing eyes) -Dysphasia -decreased perception to pain, touch, temp -bladder and bowel disturbances (urgency, frequency, retention, and incontinence) -emotional changes (apathy, euphoria, irritability, depression) -Memory changes and confusion
55
How to diagnose MS
Lumbar puncture (CSF is high in IgG *imnuno globulin) and Myelin) EEG CT MRI
56
What is medical management for MS
Corticosteroids Immunomodulatory agents Muscle relaxants Other meds to address individual symptoms
57
What are nursing diagnosis (risk for) MS
-fatigue -self-care deficit -Low self-esteem -powerlessness/hopelessness -Risk for ineffective coping -ineffective, family coping -Impaired urinary elimination
58
What are nursing interventions for MS
-provide bedrest during exasperation -Protect from injury -Place eyepatch for diplopia -Monitor for potential complications -promote regular elimination -Encourage independence -Assist client to establish regular exercise and rest -Instruct the client to balance, moderate activity with rest -provide assistive devices -Initiate physical and speech therapy -Increase fluid in taking a balanced diet -Safety measures -Follow meditation routine
59
What is a migraine headache?
Neurovascular disorder that causes severe head pain
60
How long do migraines typically last?
4 to 72 hours
61
What is an aura in regards to migraine
A visual or sensory disturbance Types of auras include Flashing lights Spots and vision Dizziness/vertigo Nausea Aphasia
62
What are causes of migraine headaches
Possible activation of the CN V Dilation of cerebral arteries Similar features to seizures
63
What are risk factors for migraine, headaches
Family Gender : women are more prone
64
What are potential triggers for migraine headaches
Bright/flashing lights Stress Anxiety Menstruation Sleep deprivation Food : especially food, containing MSG, or Tyramine
65
What foods are high in Tyramines
Red wine Hard cheese Aged meat products
66
What are manifestations of migraines?
Throbbing head pain Nausea/vomiting Photophobia phonophobia
67
How do you diagnose migraine headaches
Labs CT (to rule out other cerebral pathology) Sleep study (correlation between migraines and sleep apnea)
68
What are medical management options for migraines?
NSAIDs Eegotamine Triptan meds Calcitonin gene relates peptide receptor antagonist Caffeine Nausea meds Seizure meds Beta blockers
69
What does patient education regarding migraine, headaches
Identify and avoid triggers Provide dark and quiet environment Administer meds as directed
70
What a cluster headaches
A specific migraine variant (throbbing) Unilateral Typically occurs at the same time of day More common in the spring, and fall
71
What are causes for cluster
Similar to migraine Potential sudden release of histamine or serotonin at the CNV
72
What are manifestations of cluster headaches
Severe, unilateral have pain Often behind that eye Accompanied by : nasal congestion, facial, sweating, drooping eyelids, tearing, generalized agitation
73
Risks, diagnostics, and medical management for cluster headaches
Same as migraine
74
What is a CVA (stroke)
Cerebral vascular accident A disruption of the blood supply to part of the brain Sometimes called TIA (transient, ischemic attack)
75
What can CVA/stroke cause
Temporary or permanent loss of movement, thought, memory, speech, or sensation
76
What are risk factors for CVA?
-Age (55+) -Gender (male) -Race (African-American) -Hypertension -A fib -Hyper lymphedema -Obesity -smoking -Diabetes -Periodontal disease -asymptomatic, carotid, stenosis, and that’s valvular heart disease
77
What are the two causes of strokes?
1) ischemic 2) Hemorrhagic
78
What is an ischemic cause for CVA?
*block* Thrombotic Emboli 60% occur during sleep
79
What is a hemorrhagic it cause for a CVA
*bleeding* -Elevated BP -Bleeding disorder -AV malformation (aneurysm)
80
What is the acronym for recognizing a stroke?
Be fast Balance Eyes Face Arms Speech Time
81
What are the manifestations of CVA?
-Numbness or weakness of the Face -Changes in mental status -Trouble speaking -Trouble understanding speech -Visual disturbances -Homonymous hemianopsia (visual loss of one side) -loss of peripheral vision -Hemiparesis (weakness on one side of body) -HemiPlegia -ataxia -Dysarthria (difficulty changing the volume of speech) -Dysphasia -Paresthesia -expressive aphasia -Receptive aphasia -Global aphasia
82
What is expressive aphasia?
Aka Broca’s aphasia Person knows what they want to sing, happier and able to produce the words or sentence They cannot properly express themselves
83
What is receptive aphasia
Aka wernickes aphasia Difficulty, understanding, written, and spoken language
84
What is global aphasia?
Affects both expressive and receptive
85
How do you diagnose ETA?
12 lead EKG CT Doppler studies Arteriography
86
How do you assess CVA?
Understand time of onset is crucial Past medical history Vital signs Neuro check Aphasia
87
What is the treatment for CVA?
ABC’s Control blood pressure Anticoagulant (after hemorrhage has been ruled out) Neuroprotective agents TPA
88
How should nurse is assessing CVA?
-change in LOC or responsiveness -Presence or absence of voluntary or involuntary movements of extremities -Stiffness or facility of the neck -eye-opening, comparative size of people and pupillary reaction to light -Color of the face and extremities -temperature and moisture of the skin -Ability to speak -Presence of bleeding -maintenance of blood pressure -Mental status -Motor control
89
What are nursing diagnosis (risks involved with) CVA?
-impaired physical mobility -Acute pain -Disturb sensory perception -Deficient self-care -Impaired urinary elimination -Disturbed that process -impaired verbal communication -Risk for impairs can integrity -Interrupted family process -Sexual dysfunction
90
What are nursing interventions for CVA?
Positioning Prevent Flexion Prevent adduction Prevent edema Full range of motion Prevent venous stasis Regain balance Personal hygiene Manage sensory difficulties Visit a speech therapist Avoiding pattern Be consistent with patient activities Assess skin
91
What are discharging home care/education for patients who have had a CVA
Consult an occupational therapist Physical therapist Antidepressant Support group Assess caregivers
92
What is Bell’s palsy?
Affects cranial nerve number 7 -Caused by irritation of a nerve (usually viral) -causes unilateral facial paralysis Looks like CVA, but other muscles are not affected
93
What does management for Bell’s palsy?
Oral steroids Antiviral medication NSAIDs May require taping close the effected eyelid Usually results within 7 to 10 days
94
What does diabetes mellitus mean?
Diabetes: excessive urination Mellitus : sweet tasting
95
what does glucagon do?
Signals delivered to release glucose
96
What does insulin do?
Take glucose into the cells
97
What works together to help maintain appropriate blood glucose level
Insulin and glucagon
98
What is normal blood glucose level?
Between 70-100 mg/dl
99
What are pre-diabetic levels
100-125
100
What are DM levels
>125
101
What is type one diabetes?
Autoimmune disorder Body does not make insulin (bc Islet cells are destroyed) Extra info: -kidneys can only reabsorb so much glucose -Extra is Peed out -Fluid follows the glucose leading to dehydration -body starts to break down fat leads to key tones -Fruity breath
102
What is type two diabetes?
Cells become resistant insulin “ rusty lock” Sometimes there is a decrease in insulin production
103
What are the causes for type two diabetes?
Family history/genetics Obesity Prolong steroid use
104
What is gestational diabetes
Placental, hormones, cause insulin resistance Mothers levels go back to normal after birth
105
What are the names of rapid acting insulin
Lispro Aspart Glulisine
106
What is the name of short acting insulin
Regular
107
What is the of intermediate insulin
NPH
108
What are the names of long acting insulin?
Glargine Determir
109
Rapid acting insulin Onset Peak Duration
15-20 mins 1-2 hours 4-6 hours
110
Short acting insulin Onset Peak Duration
30mins - 1 hr 2-4 hrs 6-8 hrs
111
Intermediate acting insulin Onset Peak Duration
2-4 hrs 8-10 hrs 14-20 hrs
112
Long acting insulin Onset Peak Duration
1-2 hrs None 24 hrs
113
What are the 5 oral meds for diabetes
-biguanides -sulfonylureas -alpha-glucosidase inhibitors -Thiazolidinediones -dipeptidyl-peptidase -4
114
What is the main biguanides
Metformin
115
What are the main sulfonylureas?
-Glipizide -Glimepiride
116
What is the main thiazolidinediones
Pioglitasone
117
What is the main dipeptidyl-peptides-4
Sitagliptin
118
What are patients at risk for who have diabetes (nursing diagnosis)
-unstable blood glucose levels -Infection -deficient knowledge -disturbed sensory perception (lack of nerve endings) -impaired skin integrity -Ineffective peripheral tissue perfusion
119
What are nursing priorities when handling diabetes
-restore fluid/electrolytes -correct/reverse metabolic issues -identify/assist with underlying causes -prevent complications -educate
120
What are characteristics / manifestations of asthma
Cough Dyspnea Wheezing
121
What are the main medications for respiratory disorders
1) short-acting beta 2 (in the lungs) -adrenergic agonists (SABA) 2) anticholinergics 3) corticosteroids 4) leukotriene modifiers 5) immunomodulators
122
What do shirt-acting beta 2 adrenergic agonists (SABA) do?
Nebulizer -albuterol -ipratropium - Treat acute symptoms and prevention of exercise induced asthma.
123
How do anticholinergics work?
Inhibit muscarinic cholingergic receptors Reduce intrinsic vagal tone of airway
124
How do corticosteroids work?
Alleviating symptoms, improving airway function, decreasing peak flow variability
125
How do leukotriene modifiers work?
Anti- leukotrienes are bronchoconstrictors, so leukotrienes dilate blood vessels and alter permeability
126
How do immunomodulators work?
Prevent binding IgE to the high affinity receptors of basophils and mast cells
127
How do you measure pulmonary function ?
-tidal volume (TV) -minute volume (MV) -vital capacity (VC) -functional residual capacity (FRC) -residual volume
128
What is tidal volume?
“Normal breathing” Amount of air inhaled or exhaled during normal breathing
129
What is minute volume?
Total amount of air exhaled per minute
130
What is vital capacity?
Total volume of air that can be exhaled AFTER inhaling as much as you can
131
What is functional residual capacity?
amount of air left after exhaling
132
What is residual volume?
Amount of air left in lungs after exhaling as much as possible
133
What is total lung capacity?
Total volume of the lungs when filled with as much air as possible
134
What is forced vital capacity?
Amount of air exhaled forcefully and quickly after inhaling as much as you can
135
What is forced expiratory volume
Amount of air expired during first, second, and third seconds of FVC test
136
What is forced expiratory flow?
Average rate of flow during the middle half of FVC test
137
What is peak expiratory flow rate?
Fastest rate that you can force air out of your lungs
138
Describe chronic bronchitis “Blue bloater”
Overweight Cyanotic Elevated hemoglobin Peripheral edema (extra weight) Rhonchi and wheezing Daily productive cough for 3 months or more, in 2 consecutive years
139
Describe emphysema “Pink puffers”
-older and thin -severe Dyspnea -quiet chest -X-ray hyperinflation with flattened diaphragms
140
What are adverse reactions to inhaled anticholinergic *ipratropium
Dry mouth Irritation of pharynx Increased intraocular pressure Urinary retention
141
What are the adverse reactions to Methylxanthines *theophylline
When exceeded: Restlessness Insomnia Nausea Vomiting Diarrhea Toxic levels Seizures Dysrhythmias
142
What are adverse reactions to glucocorticoids *beclomethasone Inhaled, long term Prednisone, short term
Inhaled: Oral candidiasis Oral: Suppression of adrenal function Bone demineralization Muscle wasting Hyperglycemia Peptic ulcer disease Infection Fluid and electrolyte imbalances Nasal: Dry mucous membranes Epistaxis Sore throat Headache
143
What are the adverse reactions for mast cell stabilizers *Cromolyn
Allergic reaction with known allergies
144
What are adverse reactions to Leukotriene modifiers *Montelukast
Zileuton/Zafirlukast = cause liver damage Montelukast = neuropsychiatric effects (SI)
145
Drug therapy for upper respiratory disorders
-1st gen antihistamine/sedating -2nd gen antihistamine/nonsedating -sympathomimetics -antitussives -expectorants -mucolytics
146
What is a 1st generation antihistamine/ sedating Adverse reactions
*diphenhydramine (Benadryl) Drowsiness Dizziness Anticholinergic (dry mouth, constipation)
147
What is a 2nd generation antihistamine/ nonsedating Adverse reactions
*cetrizine Management of allergic rhinitis, chronic idiopathic urticaria Drowsiness Fatigue Anticholinergic (dry mouth, nose, and throat)
148
What is an example of sympathomimetics Adverse reactions
*Phenylephrine Allergic rhinitis, sinusitis, and the common cold -CNS stimulation with oral agents (agitation, anxiety, insomnia) -increased blood pressure -tachycardia/ palpitation -OD/ systemic absorption (hypertension, tachy, and heart rate palpitations) -rebound congestion w/ prolonged use of topical agents
149
What are examples of antitussives Adverse reactions
*codeine (opioid) *dextromethorphan (non-opioid) Suppression of chronic / nonproductive cough -CNS depression (drowsiness, sedation) -dizziness -lightheadedness -gastrointestinal distress (nausea/vomiting) -constipation -respiratory depression -potential abuse
150
What are examples of expectorants Adverse reactions
*guaifenesin Coughs- break up mucus so it can be coughed up Dizziness Deowsines Headache GI distress Allergic reaction
151
What are examples of mucolytics Adverse reactions
*acetylcysteine Decreases viscosity of mucous secretions Reverse Tylenol OD Brochospasms GI distress (rotten-egg smell) ***consume 2000 to 3000 ml of water***