Exam 3 Flashcards
Parkinson’s symptoms
3 Cardinal Symptoms (bradykinesia, resting tremor, rigidity) postural instability symptoms start unilaterally pill rolling eyelid blinking no arm swinging when walking dysphonia (soft voice) micrgraphia (tiny handwriting) loss of postural reflexes (head bowed, shoulders stooped) dysphagia slowed, slurred speech masked facies (expressionless) generalized weakness constipation orthostatic hypotension flushing, diaphoresis bladder problems drooling
Drugs that cause parkinsonism
Antipsychotics (haldol, lithium) Antiemetics (compazine) Reglan Antihypertensives (reserpine, aldomet) Methamphetamines
Fall precautions
low bed bed locked fall bracelet call light close non-slippery shoes open pathways no throw rugs
Aspiration precautions
HOB up before and after meals lung sounds watch for pocketing of food thickened liquids soft food
Parkinson’s drugs
Sinemet (levadopa and carbidopa)
- -carbidopa inhibits peripheral conversion of levodopa so more can reach brain
- -complications (dyskinesia/involuntary movements, dystonia/muscle stiffening,on-off phenomenon, wearing off phenomenon/must give on time)
Medication therapy for Parkinson’s
increase dopamine
decrease acetylcholine
–treat symptoms to maximize functional abilities while minimizing side effects
Benign Prostatic Hypertrophy (BPH)
Voiding symptoms-- difficulty initiating stream reduced force of the urinary stream intermittency dribbling incomplete emptying frequency urgency nocturia could have renal complications
Diagnosis of BPH and Prostate Cancer
Digital Rectal Exam (DRE) --uniform, elastic, non-tender in BPH --stony hard nodule in prostate cancer Prostate Specific Antigen (PSA) --elevated in both --normal is 4-10ng/ml
Conservative care for BPH
–Watch /wait to see if urinary difficulties
–Dietary changes (no alcohol, caffeine, no fluids at bedtime, avoid lrg amounts in short time
–Avoid meds that cause urinary retention (decongestants, anticholinergics)
–drugs
5 alpha-reductase inhibitors (proscar)–shrinks prostate, lowers level testicular androgens that stimulate prostate growth
Alpha-adrenergic receptor blocker (hytrin, cardura, flomax)–promote smooth muscle relaxation, side effects postural hypotension and dizziness
Transurethral Resection of the Prostate (TURO) and continuous bladder irrigation (CBI)–Post-op care
Pre-op–check clotting factors (PT/INR/PTT)
Post-op–clots normal 24-36 hours
–bleeding common complication (hematuria), bladder spasms
–normal saline irrigation for 24 hours (flushes out clots)
–adjust irrigation fluid to maintain colorless or light pink drainage
–tape cath to leg
–increase oral fluids (2-3 L)
–watch for UTI
–avoid heavy lifting
Hormonal therapy for Prostate cancer
Estrogens–inhibit release of LH (luteinizing hormone) from pituitary gland/stops hormone stimulation to the prostate
–Megace or Depo-Provera
Emergency Care of SCI
Treat as SCI if Head (esp. face) or spine involved or fall from heights
- -maintain airway
- -immobilize on backboard w/cervical collar
- -prevent head flexion, rotation, or extension
- -solu medrol given w/in 8 hrs of SCI–high doses to stop edema–not for penetrating injuries
- -edema can extend up cord creating worse injury
Cervical traction/Halo traction
- -used for high to mid cervical fractures w/out cord injury
- -requires pin care
- -Always continuous
- -assess for alignment
- -10-12 weeks
- -Do NOT raise HOB until ordered
- -walker
- -swivel chair
- -sponge bath
- -do not use bars to move patient
- -Do not lift >10lbs
- -low heeled shoes
- -button up shirts
- -straws for drinking
C-collars
- -have 2 collars available
- -change collar while sitting or standing in front of mirror
- -snug but not tight (two finger)
- -should prevent nodding yes or no
- -complication=pressure ulcers
Acute complications of SCI:
Spinal shock and hyperkalemia
(30 minutes to 6 weeks)
Shock–hypotension, bradycardia
- -warm dry extremities
- -inability to regulate temperature
- -areflexia below level of injury
- -no sensation, movement (flaccid)
Hyperkalemia–loss of K+ from paralyzed muscle
- -Kayexylate (preferred)
- -diuretics if tolerated by hypotension
- -insulin
Autonomic dysreflexia symptoms/causes and treatments (Chronic)
Causes --bladder or bowel distention --tight dressings --decubitus ulcers --pregnancy --anything that causes pain below legion Symptoms --sudden, severe hypertension (250/180) --pounding headache --bradycardia --arterial dilation, flushed skin, sweating above T6 --nasal congestion --cool skin /goose bumps below injury Treatment --SIT UP --Monitor BP frequently --look for cause and alleviate --meds (vasodilators)--apresoline, procardia, NTG Complications --stroke --MI --Seizures --renal or retinal hemorrhage
Quadriplegia/Paraplegia
Quadriplegia
–C1 thru C8
–paralysis involving all four extremities
Paraplegia
–T1 thru L4
–paralysis involving only lower extremities
Conservative treatment for back pain
Brief bed rest–2 days
- -exercises after acute pain subsides
- -ice/heat/massage
- -body mechanics
- -traction
- -meds (NSAIDs, analgesics, muscle relaxants, steroids
Myelogram
Lumbar puncture /injection of contrast dye into subarachnoid space Shows: bony overgrowth, spinal cord tumor, spinal abscess, HNP or pinched nerve Pre-procedure --Allergies to dye --BUN and creatinine --NPO 4-8 hours --D/C drugs that lower seizure threshold (metformin, phnergan, TCAs) and anticoagulants Post-procedure --force fluids --low to semi-fowler position --assess for voiding --assess LE movement --assess for spinal headache
Post-op Laminectomy
- -Always log roll
- -Do not ambulate w/out order
- -Do not raise HOB w/out order
- -Always have draw sheet on bed
- -Report any neuro deficit
- -Avoid drugs that cause increased bleeding
- -No NSAIDs–want inflammation
- -antibiotics/pain management/stool softeners
Cauda Equina Syndrome
Complete bilateral compression of lower lumbar and sacral roots–herniated out whole lower back
Causes sensory and motor loss below level of lesion
–flaccid lower extremeties, <DTRs, urinary/fecal incontinence or retention
SURGICAL EMERGENCY!!
Trigeminal Neuralgia
Unilateral facial pain–burning, knifelike, including lips, upper or lower gums, cheek, forehead, or side of nose–can come and go
–bouts of pain provoked by minimal stimulation of trigger zone (eating, brushing teeth, talking)
Treatment–meds (antiepileptic/tegretol/tripeptal or antidepressants/amitriptyline or muscle relaxants/baclofen
–surgery (glycerol rhizotomy/chemical ablation or percutaneous rhizotomy/radiofrequency ablation or microvascular decompression/targeted radiation to site
Peripheral Neuropathy
Symptoms --muscle weakness --stabbing, cutting, searing pain --paresthesia (tingling, burning numbness) --loss of sensation --impaired reflexes Meds --antiepileptic-gabapentin --antidepressant-nortriptyline --opioids Teaching --smoking worsens --protect extremities from burns, trauma, temp changes --elastic stockings to facilitate venous return
Bell’s Palsy
CN VII on one side of face --facial weakness and paralysis --full recovery in most pts after 6 months Meds --prednisone --acyclovir --valacyclovir --famcyclovir --doxycycline if lyme disease Treatment --moist heat, gentle massage, electrical stimulation of nerve, exercise therapy to facial muscles
Botulism
Symptoms --N/V --abdominal cramping --neurologic (photophobia, ptosis, paralysis of extraocular muscles, blurred vision, dry mouth, difficulty swallowing, difficulty in convergence of eyes) --paralytic ileus --muscle weakness --seizures --respiratory problems Treatment --Botulinum antitoxin --GI tract purges (laxatives, enemas, gastric lavage with charcoal)
Tetanus
–enters thru traumatic deep wound
–stiffness in jaw or neck
–fever
–tonic convulsions
–laryngeal and respiratory spasm causing apnea
–overstimulation of sympathetic nervous system (diaphoresis, labile HTN, tachycardia, arrhythmias, hyperthermia
Treatment
–tetanus toxoid booster
–control of spasms with deep sedations (valium, barbiturates
–PCN or other antibiotics
Risk factors for stroke
Heredity age male African American HTN obesity diabetes smoking hyperlipidemia heavy alcohol intake physical inactivity cocaine abuse carotid stenosis oral contraceptive use atrial fibrillation
Health promotion to prevent stroke
Control BP (< 120/80) stop smoking exercies maintain ideal body weight decrease fat intake daily aspiring eat fish 2-3 times/week no oral contraceptives if smoke decrease alcohol intake adequate vitamin # and B decrease salt intake
Stroke symptoms
sudden numbness or weakness in face, arm, leg
difficulty understanding speech, loss of speech
dizziness
visual disturbances
unexplained severe headache
change in personality or mental status
sudden loss of consciousness or syncope
OLDER ADULTS–atypical–falling, failure to eat/drink, memory loss, urinary incontinence
TIA (transient ischemic attack)
- -cerebral ischemia (w/out infarction)
- -usually less than 1 hour
- -most resolve but pt should go to ER b/c don’t know if it will progress to stroke
- -temporary loss of vision, hemiparesis, numbness, aphasia, tinnitus, vertigo, ataxia (difficulty walking)
Ischemic stroke
thrombosis (stationary clot) or embolism (moving)
- -tPA
- -anticoagulants (heparin, coumadin, ASA, plavix)
- -cautious treatment of HTN
Hemorrhagic stroke
bleeding into brain
due to ruptured vessel
sudden onset
30-50 mLs=hemorrhage
Causes
–HTN, aneurysms, AV malformation, coagulation disorders, drugs, trauma, brain tumor, bleeding
Symptoms
–severe headache, N/V, slurred speech
Complications
–hydrocephalus, seizures, vasospasm, rebleeding
–may require craniotomy to clip aneurysm or remove blood from brain
tPA (Recombinant tissue plasminogen activator)
super clot buster--give w/in 3-4.5 hours of stroke (therapeutic window) --major adverse effect=bleeding Contraindications --taking anticoagulants abnormal coagulation (PTT) --BP > 185/110 --recent GI bleed --recent stroke, head trauma, or surgery w/in 14 days --pregnant
Neglect Syndrome
Does not recognize one side of body
- -break tasks down into one-step directions
- -have pt complete one task at a time
- -position objects w/in visual field
- -cue pt to scan environment
- -develop routine for self-care
- occupational therapy
Emergency management of stroke
- -Administer O2
- -Monitor VS (want MAP<130)
- -assess baseline neurological status (GCS, –pupils, motor and sensory function)
- -IV access with NS
- -Labs (electrolytes-may have hyponatremia from excess ADH), glucose
- -Seizure control and precautions
- -assess gag reflex and institute feeding precautions
- -at risk for IICP
- -TIME IS BRAIN
Stroke and immobility
trapeze side rails up roll on good arm and push away from bed non-slip slippers call for assistance transfer techniques unaffected side first out of bed PT ROM to prevent contractures proper positioning (support arms, footboard, splints, handrolls, lap boards)
Functions of kidneys
maintain body fluid volume and composition filter waste products for elimation acid-base regulation regulate BP; thru hormone renin erythropoietin for RBC synthesis metabolize vitamin D to an active form
renal terminology
oliguria–decreased urine output 100-400 mL/24 hrs
anuria–no urination 2000 mL/24 hrs
uremia–full-blown renal failure
Diagnostic studies for urinary/renal
*Urinalysis–color, odor, turbidity (cloudiness)
*Urine culture and sensitivity–analysis for number/type of organisms present and antibiotics that will work, must be clean catch
serum creatinine–good indicator of kidney function, normal <1.3, SUPER impt test
*BUN–indicates renal excretion of urea nitrogen
*BUN/creatinine ratio–normal ratio (12:1)=kidney damage. Not normal=dehydration or poor renal perfusion
*Creatinine clearance-24 hour collection, most indicative of kidney damage, NL 70-135 mL/min
*KUB (kidneys, ureters, bladder)–plain film of abdomen, shows shape, size, and position of urinary tract
*Bladder scan–portable ultrasound @bedside–shows how much urine in bladder
*Cystoscopy–inspects interior of bladder with lighted scope, detects tumors, inflammation, prostate, strictures, structural irregularities
*Renal ultrasound
