Exam 1 Flashcards
What type of disorders fall under the nervous system?
Seizures
Meningitis
Encephalitis
Parkinson’s
Multiple sclerosis
Migraine and cluster headaches
Cerebral vascular accident (CVA)/stroke
What is a seizure?
An abnormal electrical discharge in the brain. It interrupts normal brain function
Alters awareness, abnormal sensation, focal involuntary movements, or convulsions
What is epilepsy?
A chronic seizure disorder
What are the two different types of seizures?
Generalized
Partial
What is a generalized seizure?
Discharges occurs throughout the entire brain
Typically loss of consciousness
What is a partial seizure?
Only one half of the brain is affected.
Also called a focal seizure
Typically manifest as one structural abnormality
What are causes of seizures?
Genetics
Metabolic disorders
Mitochondrial diseases
Single gene mutation
Structural abnormalities (tumors, edema, increased ICP) ***brain stress
What are the phases of a seizure?
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
Manifestations of seizures
-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
How do you diagnose a seizure?
-head CT
-MRI
-EEG
-Lumbar puncture
-Electrolyte study
-Prolactin levels
What medications are used to manage seizure disorders?
Made medication is an anticonvulsant
Examples:
Levetiracetam (Keppra)
Carbamazepine
Oxcarbazepine
Lamotrigine
Phenytoin
Valproic
Fosphenytoin
Gabalentin
What are non-medication options to help manage seizure disorders
-Special diet (ketogenic/Atkins)
-Vagal nerve stimulation
-Implantable neurostimulator
-Lobectomy/lesionectomy
-activity modification/restrictions (driving, climbing, ladders, cooking, power tools/dangerous equipment, swimming, baths)
Nursing diagnoses (risks associated with) seizures
-Risk for trauma or suffocation
-Risk for an effective airway clearance
-Situational, low self-esteem
-Deficient knowledge
-Risk for injury
What history needs to be gathered during a nursing assessment for seizures
-Age they were at onset
-Frequency
-treatments they’ve had
-What are symptoms/manifestations are
What are nursing interventions for a seizure disorders?
-prevent injury
-Maintain airway
-educate patient and family (safety, triggers, compliance with meds)
What is meningitis?
Inflammation (swelling) of the protective membranes, covering the brain and spinal cord. Can lead to ICP
What are the causes of meningitis?
Usually caused by an infection:
Bacterial
Viral
Fungal
Parasitic
Amebic
What are the manifestations of meningitis?
Fever
Seizure
Neck stiffness
Positive Kernig’s sign
Positive brudzinski sign
Neurologic symptoms
Photalgia (photophobia)
What is Positive brudzinski sign?
Lift head up to put chin to chest, with involuntary flexing of hips and knees *a reaction to the stretch)
What is a positive Kernig’s sign?
(inability to extend knees more than 135 degrees)
What is the worst kind of meningitis?
Bacterial meningitis
Specifically; meningococcal
Where is Meningococcal meningitis commonly seen
Communal living situation
College dorm
Military barracks 
What are signs and symptoms of bacterial meningitis?
Fairly sudden onset of the following symptoms
Fever
Headache
Stiff neck
Rush
What are other possible signs of bacterial meningitis?
Nausea/vomiting
Sensitivity to light
Confusion
Drowsiness
Convulsions
Joint pain
Cold hands and feet
,coma
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
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
How do you diagnose meningitis?
Lumbar puncture
CBC
Blood culture
Head CT
How do you treat bacterial meningitis?
-Antibiotics
-Control fever and pain
-IVF (IV fluids)
-Possible mechanical ventilation
-Possible ICP monitoring
How do you treat viral meningitis?
-Antiviral medication
-Control pain and fever
-IVF
-Possible mechanical ventilation
What are the main things that need to be assessed for meningitis?
-Neurological status
-Pulse ox
-Arterial blood gas
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
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)
What is encephalitis?
Inflammation of cerebral tissue
What causes encephalitis?
Most commonly caused by the herpes virus
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
What are signs of brain stem involvement?
Nystagmus (eye twitching)
extraocular nerve palsies
Hearing loss
Dysphagia
Respiratory dysfunction
What medications are used to treat encephalitis
Antivirals
Anticonvulsants
Steroids
Pain management
Sedatives
What is Parkinson’s disease?
A degenerative disease that is caused by depletion of dopamine
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
When does mental deterioration occur in Parkinson’s disease?
In the late stages
What are causes of Parkinson’s disease?
Hereditary
Drug induced (dopamine, depleting drugs)
What are examples of dopamine depleting drugs?
Reserpine
Phenothiazine
Metocloprmide
Tetrabenazine
Droperidol
Haloperidol
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
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
How do you diagnose Parkinson’s?
Physical exam
Levodopa challenge (put them on med and see if there’s an improvement)
PET
MRI
What are the medical/medication used to manage Parkinson’s disease?
Levodopa
Neurosurgery
Neurologic implants
PT/OT
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
What is the proper diet for someone with Parkinson’s disease?
High calorie
High protein
High-fiber
Soft
Small
Frequent feedings
NO B6
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
What is multiple sclerosis?
Chronic, progressive, non-contagious, degenerative disease of the CNS
Demyelinization of neurons
What is attacked during multiple sclerosis?
Myelin sheath around the nerves
What are the causes of multiple sclerosis?
Unknown
Might be autoimmune
What are risk factors that can lead to multiple sclerosis
Pregnancy
Fatigue
Stress
Infection
Trauma
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
How to diagnose MS
Lumbar puncture (CSF is high in IgG *imnuno globulin) and Myelin)
EEG
CT
MRI
What is medical management for MS
Corticosteroids
Immunomodulatory agents
Muscle relaxants
Other meds to address individual symptoms
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
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
What is a migraine headache?
Neurovascular disorder that causes severe head pain
How long do migraines typically last?
4 to 72 hours
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
What are causes of migraine headaches
Possible activation of the CN V
Dilation of cerebral arteries
Similar features to seizures
What are risk factors for migraine, headaches
Family
Gender : women are more prone
What are potential triggers for migraine headaches
Bright/flashing lights
Stress
Anxiety
Menstruation
Sleep deprivation
Food : especially food, containing MSG, or Tyramine
What foods are high in Tyramines
Red wine
Hard cheese
Aged meat products
What are manifestations of migraines?
Throbbing head pain
Nausea/vomiting
Photophobia
phonophobia
How do you diagnose migraine headaches
Labs
CT (to rule out other cerebral pathology)
Sleep study (correlation between migraines and sleep apnea)
What are medical management options for migraines?
NSAIDs
Eegotamine
Triptan meds
Calcitonin gene relates peptide receptor antagonist
Caffeine
Nausea meds
Seizure meds
Beta blockers
What does patient education regarding migraine, headaches
Identify and avoid triggers
Provide dark and quiet environment
Administer meds as directed
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
What are causes for cluster
Similar to migraine
Potential sudden release of histamine or serotonin at the CNV
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
Risks, diagnostics, and medical management for cluster headaches
Same as migraine
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)
What can CVA/stroke cause
Temporary or permanent loss of movement, thought, memory, speech, or sensation
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
What are the two causes of strokes?
1) ischemic
2) Hemorrhagic
What is an ischemic cause for CVA?
block
Thrombotic
Emboli
60% occur during sleep
What is a hemorrhagic it cause for a CVA
bleeding
-Elevated BP
-Bleeding disorder
-AV malformation (aneurysm)
What is the acronym for recognizing a stroke?
Be fast
Balance
Eyes
Face
Arms
Speech
Time
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
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
What is receptive aphasia
Aka wernickes aphasia
Difficulty, understanding, written, and spoken language
What is global aphasia?
Affects both expressive and receptive
How do you diagnose ETA?
12 lead EKG
CT
Doppler studies
Arteriography
How do you assess CVA?
Understand time of onset is crucial
Past medical history
Vital signs
Neuro check
Aphasia
What is the treatment for CVA?
ABC’s
Control blood pressure
Anticoagulant (after hemorrhage has been ruled out)
Neuroprotective agents
TPA
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
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
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
What are discharging home care/education for patients who have had a CVA
Consult an occupational therapist
Physical therapist
Antidepressant
Support group
Assess caregivers
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
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
What does diabetes mellitus mean?
Diabetes: excessive urination
Mellitus : sweet tasting
what does glucagon do?
Signals delivered to release glucose
What does insulin do?
Take glucose into the cells
What works together to help maintain appropriate blood glucose level
Insulin and glucagon
What is normal blood glucose level?
Between 70-100 mg/dl
What are pre-diabetic levels
100-125
What are DM levels
> 125
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
What is type two diabetes?
Cells become resistant insulin
“ rusty lock”
Sometimes there is a decrease in insulin production
What are the causes for type two diabetes?
Family history/genetics
Obesity
Prolong steroid use
What is gestational diabetes
Placental, hormones, cause insulin resistance
Mothers levels go back to normal after birth
What are the names of rapid acting insulin
Lispro
Aspart
Glulisine
What is the name of short acting insulin
Regular
What is the of intermediate insulin
NPH
What are the names of long acting insulin?
Glargine
Determir
Rapid acting insulin
Onset
Peak
Duration
15-20 mins
1-2 hours
4-6 hours
Short acting insulin
Onset
Peak
Duration
30mins - 1 hr
2-4 hrs
6-8 hrs
Intermediate acting insulin
Onset
Peak
Duration
2-4 hrs
8-10 hrs
14-20 hrs
Long acting insulin
Onset
Peak
Duration
1-2 hrs
None
24 hrs
What are the 5 oral meds for diabetes
-biguanides
-sulfonylureas
-alpha-glucosidase inhibitors
-Thiazolidinediones
-dipeptidyl-peptidase -4
What is the main biguanides
Metformin
What are the main sulfonylureas?
-Glipizide
-Glimepiride
What is the main thiazolidinediones
Pioglitasone
What is the main dipeptidyl-peptides-4
Sitagliptin
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
What are nursing priorities when handling diabetes
-restore fluid/electrolytes
-correct/reverse metabolic issues
-identify/assist with underlying causes
-prevent complications
-educate
What are characteristics / manifestations of asthma
Cough
Dyspnea
Wheezing
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
What do shirt-acting beta 2 adrenergic agonists (SABA) do?
Nebulizer
-albuterol
-ipratropium
-
Treat acute symptoms and prevention of exercise induced asthma.
How do anticholinergics work?
Inhibit muscarinic cholingergic receptors
Reduce intrinsic vagal tone of airway
How do corticosteroids work?
Alleviating symptoms, improving airway function, decreasing peak flow variability
How do leukotriene modifiers work?
Anti- leukotrienes are bronchoconstrictors, so leukotrienes dilate blood vessels and alter permeability
How do immunomodulators work?
Prevent binding IgE to the high affinity receptors of basophils and mast cells
How do you measure pulmonary function ?
-tidal volume (TV)
-minute volume (MV)
-vital capacity (VC)
-functional residual capacity (FRC)
-residual volume
What is tidal volume?
“Normal breathing”
Amount of air inhaled or exhaled during normal breathing
What is minute volume?
Total amount of air exhaled per minute
What is vital capacity?
Total volume of air that can be exhaled AFTER inhaling as much as you can
What is functional residual capacity?
amount of air left after exhaling
What is residual volume?
Amount of air left in lungs after exhaling as much as possible
What is total lung capacity?
Total volume of the lungs when filled with as much air as possible
What is forced vital capacity?
Amount of air exhaled forcefully and quickly after inhaling as much as you can
What is forced expiratory volume
Amount of air expired during first, second, and third seconds of FVC test
What is forced expiratory flow?
Average rate of flow during the middle half of FVC test
What is peak expiratory flow rate?
Fastest rate that you can force air out of your lungs
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
Describe emphysema
“Pink puffers”
-older and thin
-severe Dyspnea
-quiet chest
-X-ray hyperinflation with flattened diaphragms
What are adverse reactions to inhaled anticholinergic
*ipratropium
Dry mouth
Irritation of pharynx
Increased intraocular pressure
Urinary retention
What are the adverse reactions to Methylxanthines
*theophylline
When exceeded:
Restlessness
Insomnia
Nausea
Vomiting
Diarrhea
Toxic levels
Seizures
Dysrhythmias
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
What are the adverse reactions for mast cell stabilizers
*Cromolyn
Allergic reaction with known allergies
What are adverse reactions to Leukotriene modifiers
*Montelukast
Zileuton/Zafirlukast = cause liver damage
Montelukast = neuropsychiatric effects (SI)
Drug therapy for upper respiratory disorders
-1st gen antihistamine/sedating
-2nd gen antihistamine/nonsedating
-sympathomimetics
-antitussives
-expectorants
-mucolytics
What is a 1st generation antihistamine/ sedating
Adverse reactions
*diphenhydramine
(Benadryl)
Drowsiness
Dizziness
Anticholinergic (dry mouth, constipation)
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)
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
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
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
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
