Exam 3 Flashcards
What is a CT?
A rapid and continuous cross sectional scan used to detect problems such as a hemorrhage, tumor, cyst, edema, infarction, brain atrophy and other abnormalities (may use contrast media) (so long as patient is able to have an x-ray, no contraindications)
What is an MRI?
Magnetic energy used to detect abnormalities in soft tissue. Provides greater detail that CT and may be used to detect stroke, MS, tumors, trauma, herniation, and seizures (may use contrast for media) (BOLO for implanted metal/devices - magnet may interfere with/or traumatically remove metal in the body)
Manifestations of brain tumors
Brainstem - HA on awakening, drowsiness, vomiting, ataxic gait, facial muscle weakness, hearing loss, dysphagia, dysarthria, hemiparesis
Frontal lobe (unilateral) - unilateral hemiplegia, seizures, memory deficit, personality and judgement changes, visual changes
Frontal lobe (bilateral) - all of the above + ataxic gait
Parietal lobe - speech, inability to write, spatial disorders
Occipital lobe - vision changes and seizures
Temporal lobe - few sx, seizures, dysphagia, hallucinations, auras
Nursing interventions of tonic-clonic seizures and status epilepticus
Tonic-clonic: keep patient from self-harm, maintain airway by turning patient on side, stay with patient until seizure stops
Status epilepticus: true emergency that requires medical intervention
What is MS?
A demyelinating disease where the myelin sheath of the neuron is gradually destroyed which prevents and slows transmission of nerve impulses. (May decrease during pregnancy and increase post delivery).
Symptoms of MS
Muscle weakness in the arms and legs, trouble with coordination, impaired walking or standing, partial or complete paralysis, spasticity (involuntary increased tone of muscles leading to stiffness and spasms). Fatigue (may be triggered by physical activity, may ease with rest, or may be constant and persistent), loss of sensation, tingling or numbness, speech difficulties, tremor, dizziness, hearing loss, loss of vision or changes in vision, loss of bowel and bladder control, sexual dysfunction, pain, emotional changes, changes in reflex (may also cause cognitive effects such as concentration, attention, memory, and judgement)
What is Guillain-Barre Syndrome (GBS)?
also known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP). It is a neurological disorder in which the body’s immune system attacks the peripheral nervous system, the part of the nervous system outside the brain and spinal cord
S/Sx unique to GBS
symptoms on both sides of the body, symptoms appear quickly - days or weeks instead of months, loss of reflexes, high protein level in cerebral spinal fluid, ascending order “toes to nose” (nursing consideration: regular assessment with function, respiratory being primary concern)
What is Parkinson’s Disease?
Typically hits people at the age of 65 and is a progressive disease with no cure. Brain cells in the area of the brain called the “substantia nigra” die off.
What is secondary parkinson’s?
Exposure to certain substances like chemicals or drugs. PD can manifest after certain medications of illicit drugs are given such as metoclopramide, lithium, or haloperidol. Exposure to chemicals such as carbon monoxide or magnesium can also induce PD.
What is bacterial meningitis?
Primarily a respiratory droplet spread bacteria infection. This is a true emergency and can be fatal if untreated. Antibiotics are started even before a definitive diagnosis. Patients should be in a dark, cool room with minimal noise.
S/sx of bacterial meningitis
Painful, stiff neck with limited ROM, headaches, high fever, feeling confused or sleepy, bruising easily all over the body, a rash on the skin, sensitivity to light (CT/MRI, blood test including cultures x 2 and spinal tap are often used for diagnosis and vaccination for high risk patients is recommended)
What is alzheimer’s dementia?
Progressive and incurable, link between development of disorder and lifestyle (diet, exercise, etc.) factors is present, no genetic link
Alzheimer’s dementia s/sx
Characterized by loss of memory or inability to retain new information, poor judgement leading to bad decisions, loss of spontaneity and sense of initiative, taking longer to complete normal daily tasks, repeating questions, trouble handling money and paying bills, wandering and getting lost, losing things or misplacing them in odd places, mood and personality changes, increased anxiety and/or aggression, exclusion
Types of CVA and what they are
hemorrhagic: blood vessel in the brain ruptures or bleeds
thrombolytic: blood clot in the vessels of the vein
embolic: blood clot travels and gets lodged in vessels of the brain
TIME IS BRAIN know when the patient changed
What is aphasia?
Expressive: affects ability to speak
Receptive: affects ability to understand
Types: Broca’s, global, wernicke’s
What is a TIA?
Short period of time and serves as a warning. Patient with s/sx of a TIA are indistinguishable from stroke and MUST be evaluated in hospital. (tPA is only given after hemorrhage is ruled out)
Acronym to remember for stroke
B: balance
E: eyes
F: face
A: arms
S: speech
T: time since last known well
What is a closed fracture?
No skin impairment (priorities include impaired function, blood loss, and pain
What is an open fracture?
Skin impairment (priorities include closed fracture + infection; long bone fractures are at increased risk for sudden blood loss and high risk of infection compared to closed)
Hip fx considerations
toilet riser, limited hip flex, use of shower shower chairs
External fixation device (ex-fix)
watch for s/sx of infection at the pin site, proper hand hygiene, wash the limb, daily checks for infection
Amputation of limb
Contractures are of concern to residual limb (limb stump), mobility exercises and stretching is paramount in post surgical care of residual limb, skin breakdown and sensitivity considerations
What is osteoarthritis?
Progressive bone and joint degeneration, non-systemic, mostly affect weight bearing joints; age, obesity, sports, occupation related hx
What is rheumatoid arthritis?
Autoimmune; chronic, systemic, progressive joint inflammation, genetic, characterized by remissions and exacerbations
What is osteoporosis?
Low bone density, affect women more than men, other risk factors include diet (low vit D/calcium), family hx, and corticosteroid use
What is osteomyelitis?
Infection of bone and surrounding tissue, direct or indirect (ex: bloodborne), vascular insufficiency, common organisms (s. aureus & s. epidermidis), long term abx therapy (2-6 mo induration)
