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Adult Health 2 > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

tx of anaphylactic shock

A

Epinephrine, antihistamines, H2-blockers (Zantac), Bronchodilators (albuterol), Steroids

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2
Q

be fast

A 
balance
eyes
facial dropping 
arm /extremity 
speech
time
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3
Q

major cause of TIA

A

atherosclerosis

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4
Q

clot formation = blocks passage of blood through artery

A

thrombotic ; most common

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5
Q

blockage in the brain

A

ischemic

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6
Q

bleeding in the brain

A

hemorrhagic

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7
Q

major cause of hemorrhagic

A

htn

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8
Q

what do you not give a patient with hemorrhagic stroke

A

anticoag and antiplatelet

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9
Q

bleeding INSIDE brain caused by RUPTURE OF VESSEL

A

intracerebral hemorrhagic

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10
Q

s/s of intracerebral hemorrhagic

A

headache and nausea / vomitting

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11
Q

patient reports the worst headache of their life

A

subarachnoid hemorrhagic

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12
Q

receptive aphasias- LANGUAGE COMPREHENSION

A

Wernicke’s

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13
Q

expressive aphasia- SPEECH CONTROL

Brain stem- breathing

A

broca

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14
Q

PERSONALITY MOTOR FUNCTION HIGHER LEVEL SOLVING SKILL

A

frontal lobe

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15
Q

elevated bp in ischemic is what

A

this is ok because body is trying to maintain perfusion

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16
Q

platelet inhibitors to give

A

Aspirin 325 mg

clopidogrel (Plavix)

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17
Q

iicp can be caused by primary or secondary

A

primary: iicp happens at time of injury, trauma from a car accident
secondary: follows a primary injury. Hypoxia, ischemia, hypotension, edema and ultimately IIICP

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18
Q

normal icp

A

5-15

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19
Q

elevated icp

A

greater than 20

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20
Q

how do we check if there is icp

A

pressure transducer

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21
Q

1 cranial nerve

A

olfactory

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22
Q

2 cranial nerve

A

optic

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23
Q

3 cranial nerve

A

oculomotor

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24
Q

4 cranial nerve

A

trochlear

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25
Q

5 cranial nerve

A

trigeminal

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26
Q

6 cranial nerve

A

abducens

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27
Q

7 cranial nerve

A

facial

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28
Q

8 cranial nerve

A

acoustics

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29
Q

9 cranial nerve

A

glossopharyngeal

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30
Q

10 cranial nerve

A

vagus

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31
Q

11 cranial nerve

A

accessory

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32
Q

12 cranial nerve

A

hypoglossal

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33
Q

cerebral perfusion pressure

A

60-100

less than 50 is neuro death and ischemia

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34
Q

what to monitor for icp

A

glasglow coma scale best score 15
seizure safety
sensory/motor impairment
speech changes

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35
Q

priorities for icp

A

airway

fluids and electrolytes

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36
Q

most reliable indicator of patients neuro status

A

change in loc

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37
Q

what is assessed is glascow coma scale

A

eyes
verbal
motor

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38
Q

icp hallmark signs

A

cushings triad : systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations

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39
Q

posture that is worse

A

decerebrate

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40
Q

what do you not want to do for a person suspected of icp

A

no lumbar puncture because it can cause herniation

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41
Q

what is the golden standard for monitoring icp

A

ventriculostomy

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42
Q

pao2

A

greater than or equal to 100

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43
Q

paco2

A

35-45

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44
Q

characterized by decreased reflexes, loss of sensation, and flaccid paralysis below the level of the injury.
This syndrome lasts days to months and may mask post injury neurologic function.

A

spinal shock

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45
Q

what do you look at for a spinal cord injury

A

dermatomes tell you the level of impairment

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46
Q

loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia.
Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and a decreased cardiac output.

A

neurogenic shock

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47
Q

neurogenic shock is usually…

A

t6 or higher injury

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48
Q

gold standard in diagnosing stability of the injury, location and degree of injury, and degree of spinal canal compromise.

A

ct scan

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49
Q

assess for soft tissue and neurologic changes and when there is unexplained neurologic deficit or worsening of neurologic status.

A

MRI

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50
Q

rules out any vertebral artery damage

A

ct angiogram

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51
Q

what can a neurogenic bladder lead to

A

autonomic dysreflexia

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52
Q

if no gag reflex….

A

plan for intubation

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53
Q

above t6 injury

A

decrease in SNS, bradycardia, atropine to increase hr

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54
Q

prevention of dvt

A

enoxaparin

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55
Q

used to maintain the mean arterial pressure at a level greater than 90 mm Hg so that perfusion to the spinal cord is improved.

A

dopamine / intropin

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56
Q

what to monitor with patient who has a SCI

A

monitor bp; high bp but low heart rate

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57
Q

intervention for their bp

A

sit them up to prevent postural hypotension

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58
Q

nursing management for sci

A

maintain ventilation; 2) Intact skin; 3) Bowel and bladder management program; 4) no episodes of autonomic dysreflexia

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59
Q

med given for spinal cord tumors

A

dexamethasone for edema

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60
Q

glascow coma scale

A

less than 8 intubate

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61
Q

loss of csf

A

rhinorrhea and otorrhea

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62
Q

wbc

A

3-12

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63
Q

hemoglobin

A

12-18

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64
Q

bun

A

10-20

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65
Q

creatinine

A

0.6-1.2

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66
Q

fasting glucose

A

70-100

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67
Q

a1c

A

4-5.6

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68
Q

a1c for diabetics

A

less than 7.0

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69
Q

total cholesterol

A

less than 200

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70
Q

ptt

A

20-35 seconds

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71
Q

pt

A

11.2-13.2 seconds

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72
Q

inr therapeutic

73
Q

why is last known normal with a stroke patient important

A

tpa time frame is up to 4.5 hours

74
Q

testing labs for stroke

A

CT scan (#1), weight (tpa), glucose a1c, lipids, coagulants, ekg (looking for dysrhythmias), echo, mri, carotid ultra sound, dysphasia screening

75
Q

two anti platelet

A

aspirin and clopitagril

76
Q

what does NIHSS tell us

A 
tells us their disability - higher the # the worse they are. 
neuro checks (orientation, LOC, speech, and extremity testing such as pronator drift)
77
Q

diabetes, hyperlipidemia, previous stroke or tia, dysrhythmia, smoking, hypertension, sedentary lifestyle, cardiac abnormalities

A

risk factors for stroke

78
Q

black label warning medication for headaches

A

imitrex given for cad patients

79
Q

pill rolling (tremors), shuffle gait (bradykinesia), cog wheel (rigidity)

A

parkinson disease

80
Q

what is issue with dopamine

A

parkinsons

81
Q

tx for parkinsons

A

sinamet (levodopa/carvidopa)

82
Q

what are we worried about with  sinamet (levodopa/carvidopa)

A
  • Worried about adherence, dosage changes and it is divided throughout the days
  • Need consistent amount of moderate protein
  • Can be a wearing off of medications
83
Q

increased dopamine; genetic

A

hunting tons disease

84
Q

what do we want to do with pt for huntingtons

A

they experience chorea- increased movements so we need to increase their caloric needs

85
Q

progressive muscle weakness that happens in the upper body

A

myastenia gravis

86
Q

what are we worried about w MG patient

A

respirations so do a respiratory assessment

87
Q

interventions for patient with ALS

A 
	Care planning
	Cognitively intact 
	Communication
	Passive/ ROM 
	Skin assessment 
	Respiratory assessment
88
Q

signs and symptoms of multiple sclerosis

A

bladder or vision disturbances

89
Q

 sclerotic plaques on myelin sheath

A

multiple sclerosis

90
Q

MS paralysis

A

it can happen during a flare and tx w steriods to decrease the inflammation

91
Q

intervention for MS

A

try to get ADLs is at once and quickly

92
Q

intervention for epilepsy/seizure

A

find out what triggers are so they can stay away from them

93
Q

lights, stress, smells, lack of sleep, caffeine, exercise, alcohol

A

some triggers for a seizure patient

94
Q

tx for status epi

A

benzos; ending in pam

95
Q

unwitnessed seizure what are we worried about

A

head and spinal cord injury so we would do assessments to rule this out

96
Q

tx for seizures

A

gabapentin, keepra, Dilantin, Topamax

97
Q

what is important for seizure meds

A

taper them down because abrupt stopping can cause seizures

98
Q

trigeminal neuralgia

A

cranial nerve 5

99
Q

tx for trigeminal neuralgia

A

antiepileptic drugs

100
Q

bells palsy

A

cranial nerve 7

101
Q

Cause of it being HSV or herpes, meningitis, tooth infection or any upper infection

A

bells palsy

102
Q

what does bells palsy mimic

103
Q

can you recover from bells

104
Q

Autoimmune response to something such as Vaccine, viral illness, bacterium

A

o Guillain-Barre

105
Q

Guillain-Barre is paralysis

A

ascending which means it works its way up so we are worried about respiratory muscles

106
Q

can you recover from guillain barre

107
Q

interventions for Guillain-Barre

A

assessments, respiratory, psychosocial

108
Q

how do you treat viral meningitis

A

symptomatically

109
Q

how do you treat bacterial meningitis

A

antibiotics

110
Q

droplet isolation for which meningitis

111
Q

Stiff neck, nuchal rigidity, headache, photophobia, change in LOC, nausea and vomiting, papilledema

A

meningitis

112
Q

what can cause icp

A

trauma, edema, fluid build up, tumor

113
Q

interventions for patient with icp

A

having bowel movements, coughing, and turning patient

114
Q

bruising over the mastoid process as a result of a brain bleed

A

battle sign

115
Q

what to look out for with pt with icp

A

rhinorrhea, battles sign, halo sign

116
Q

spinal cord injuries

A

autonomic dysreflexia

117
Q

how do you know if a person with MOD is getting better

A

LOC improve, I and o is good, BUN, organ labs improve

118
Q

dysphasia

A

difficulty speaking

119
Q

mannitol

A

used as a diuretic to reduce cerebral edema

120
Q

what are we checking for MODs

A

LOC, temp, color

121
Q

management for mod

A

preventing dic; put them on heparin or lovanox, monitor for bleeding, bruising on skin

122
Q

• Need to know when it started, stopped, what it looked like, how long, new onset

123
Q

phases of seizure

A
  • 1) prodromal (preceding seizure)
  • 2) aural (sensory warning before seizure)
  • 3) ictal (full seizure)
  • 4) postictal (recovery after seizure)
124
Q

what kind of diet can we recommend for seizure patient

A

ketogenic; high fat low carb

125
Q

drug given for seizures and what do we want to monitor with it

A

Phenytoin (Dilantin)- liver complications

126
Q

diagnostic lab for seizures

127
Q

drugs given for symptoms with migraines

A

aspirin, acetaminophen, analgesic combo, imitrex

128
Q

what to be careful about with imitrex

A

*(avoid with heart disease/constriction of arteries)

129
Q

prophylactic drugs for migraines

A

topamax; be careful with abruptly stopping

130
Q

which is worse decorticate or decerebrate

A

decerebrate more severe (brainstem and midbrain damage)

131
Q

Kernigs sign

A

lifting knee up

132
Q

Brudinski

A

lifting head up while supporting

133
Q

modifiable risk factors associated with stroke

A

HTN, DM, hyperlipidemia, smoking, excessive alcohol, sleep apnea untreated, drug use (risk for hemorrhagic-cocaine), obesity, sedentary lifestyle, heart disease

134
Q

non modifiable risk factors with stroke

A

age, gender, race (African American-higher risk), family history
o BUT REALLY: A fib, smoking, sedentary lifestyle, DM, excessive alcohol use

135
Q

most common stroke

A

ischemic Thrombotic

136
Q

which will you see collateral circulation

A

thrombotic because it is slower onset ; this will show up on a ct scan

137
Q

rapid occurrence and lack of collateral circulation

138
Q

major cause of hemorrhagic strokes

139
Q

any stroke patient…

A

is made NPO until they have receive dysphagia screening

140
Q

what can you give for stroke patient and how is it given

A

aspirin asap unless they fail screening then it can be given rectal

141
Q

total inability to communicate; massive stroke

A

global aphasia

142
Q

loss of production of language

A

expressive aphasia

143
Q

loss of comprehension

A

receptive aphasia

144
Q

impaired ability to communicate; used interchangeably with aphasia

145
Q

ok high bp in

A

ischemic stroke

146
Q

how is NIHSS score

A

want it to be 0; higher the number the worse patient is

147
Q

drug approach for restless leg syndrome

A

Sinemet (also used for PD), Requip, Mirapeto increase dopamine in brain
• Gabapentin: to decrease sensory sensations

148
Q

disseminated demyelination of nerve fibers in brain and spinal cord; relapsing/remission disease

A

multiple sclerosis

149
Q

• Weakness, paralysis of limbs, speech patterns delayed/interrupted, patchy blindness (early S&S), tinnitus, vertigo, sex dysfunction, bowel/bladder impairments, dysphagia, ataxia, dysarthia (weak speech muscles)

A

multiple sclerosis

150
Q

“shock” sent down leg when neck flexed

A

• Lhermitte’s sign in MS

151
Q

tx pt with MS

A

do adl in morning because they fatigue, may have to straight cath themselves

152
Q

lack of dopamine in the brain

153
Q

unusual clumps of proteins; found in brains; contribute to dementia

A

lewy bodies with parkinson

154
Q

what to take for parkinson and why do some people not take it

A

sinomet- carvidopa; it takes weeks for effect so some people think it is not working

155
Q

weakness in certain skeletal groups (UPPER body); antibodies attack acetylcholine (ACh) receptors

A

myasthenia gravis

156
Q

intervention for MG

A

rr, pulmonary assessment

157
Q

in MG crisis they are high risk for

A

aspirating

158
Q

drug for mg

159
Q

what slows the process of also / drug

A

riluzole (Rilutek)

160
Q

limb weakness, dysarthria (facial muscle weakness), dysphagia (difficulty swallowing), muscle wasting, fasciculations (involuntary muscle twitching), drooling, depression, sleep disorder, esophageal reflux

161
Q

genetic, autosomal dominant

A

huntingtons disease

162
Q

excessive dopaminergic(DA), excessive involuntary movements (CHOREA)

163
Q

interventions for hunt

A

increase caloric needs due to increase in movement

164
Q

cpp needs to be

165
Q

eyes GCS

166
Q

verbal GCS

167
Q

motor GCS

168
Q

• Minor head injury: > 13 Moderate: 9-12  Severe: <8

169
Q

Pt comes in with cerebral edema…. what do we want to look out for

A

pt complaining of a headache

170
Q

cushings triad tells us about

171
Q

increased SBP, decreased HR and RR

172
Q

decreased BP, increased HR and RR

173
Q

abnormal with basilar skull fracture

A

temp being high

174
Q

what is the risk of otorrhea and rhinorrhea

A

risk for meningitis with high csf leak

175
Q

bruising of brain tissue

176
Q

brain hitting front or back of skull;worried about a c spine injury

A

 Coup-Contrcoup injury with contusion

177
Q

what to ask pt with a contusion

A

are they on anticoags ? increase risk of hemorrhage

178
Q

sudden transient mechanical injury with disruption of neuronal activity and change in LOC

A

concussion

Adult Health 2 (7 decks)

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