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Med Surg III - 2320 > Exam III > Flashcards

Exam III Flashcards

1
Q

What are the conditions that can disrupt intracerebral perfusion?

A
  • internal blockage of a vessel
  • severe hypotension
  • intracranial hemorrhage
  • Loss of vessel integrity attributable to damage or excessive external pressure that exceeds perfusion pressure
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2
Q

This condition is the result of inadequate perfusion past a thrombus or embolus

A

Ischemic stroke

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3
Q

What are the most common inflammatory conditions of the brain?

A
  • abscesses
  • meningitis
  • encephalitis
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4
Q

What population has a higher incidence of degenerative intracranial regulation problems?

A

The elderly

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5
Q

What population has a higher incidence of injury related intracranial regulation problems?

A

adolescent and young adult

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6
Q

Age, hypertension, diabetes, smoking, obesity, and cardiovascular disease are risk factors for _____?

A

Stroke

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7
Q

What are the three components of the skull?

A
  • brain tissue (80%)
  • blood (10%)
  • cerebrospinal fluid (10%)
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8
Q

What is normal intracranial pressure?

A

Less than or equal to 15 mmHg

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9
Q

Intracranial pressure measuring greater than or equal to 20 mmHg is considered _____?

A

Intracranial hypertension

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10
Q

This is the capillary system of the brain consisting of a tight layer of endothelial cells located between the arterial and venous network?

A

Blood brain barrier

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11
Q

What is the function of the blood brain barrier?

A

It is a restrictive barrier that makes it difficult for neurotoxic substances to pass into the brain

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12
Q

What secondary condition compromises the blood brain barrier?

A

Decreased perfusion

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13
Q

The area of the brain between the arachnoid layer and the pia mater is referred to as the _____?

A

Subarachnoid space

The space contains cerebrospinal fluid

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14
Q

_____ is an inflammatory condition of the meninges

A

Meningitis

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15
Q

What are the three areas of the brain particularly sensitive to hypoglycemia?

A
  • cerebral cortex
  • hippocampus
  • cerebellum
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16
Q

What are the detrimental effects of hyperglycemia with acute stroke?

A
  • worsened ischemic damage
  • increased infarction size
  • increased blood brain permiability
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17
Q

Cerebral blood flow is normally maintained at a relatively constant rate by intrinsic cerebral mechanisms referred to as _____

A

Autoregulation

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18
Q

_____ adjusts cerebral blood flow in response to the brain’s metabolic demands by changing the diameter of cerebral blood vessels.

A

Autoregulation

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19
Q

The walls of these arteries are thinner because of a lack of smooth muscle and decreased thickness of the tunica media

A

cerebral

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20
Q

What are the three circumstances in which autoregulation becomes impaired?

A
  • Mean arterial pressure <70mmHg or >170mmHg
  • Intracranial Pressure >40 mmHg
  • Localized or global cerebral injury
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21
Q

What is the rate of Cerebral Spinal Fluid production?

A

20 mL/hr

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22
Q

What are the six primary causes of cerebral edema?

A
  • Mass lesions
  • Head Injuries
  • Brain Surgery
  • Cerebral Infection
  • Vascular Insult
  • Toxic or Metabolic Encephalopathic conditions
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23
Q

What are the types of mass lesions that can cause cerebral edema?

A
  • Brain abscess
  • Brain Tumor (primary or metastatic)
  • Hematoma (intracerebral, subdural, epidural)
  • Hemorrhage (intracerebral, cerebellar, brainstem)
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24
Q

What are the complications that occur with head injuries and brain surgery that can cause cerebral edema?

A
  • Contusion
  • Hemorrhage
  • Post traumatic brain swelling
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25
Q

What are the types of cerebral infections that can cause cerebral edema?

A
  • Meningitis

- Encephalitis

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26
Q

What are the types of vascular insult that can cause cerebral edema?

A
  • Anoxic and ischemic episodes
  • Cerebral infarction (thrombotic or embolic)
  • Venous sinus thrombosis
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27
Q

What are the toxic or metabolic encephalopathic conditions that can cause cerebral edema?

A
  • Lead or arsenic intoxication
  • Hepatic encephalopathy
  • Uremia
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28
Q

____ is a compensatory mechanism that causes vasoconstriction, which reduces cerebral blood volume and ICP.

A

Hyperventilation

Carbon dioxide is a potent vasodilator

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29
Q

What is the intracranial pressure for Pathologic ICP?

A

Sustained pressure > or = to 20 mmHg

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30
Q

What conditions cause increased ICP?

A
  • Traumatic brain injury (TBI
  • Ruptured aneurysm
  • CNS Infections
  • Hydrocephalus
  • Brain tumors
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31
Q

What are the symptoms of ICP?

A
  • Headache
  • Decreased LOC
  • Vomiting
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32
Q

What are the signs of ICP?

A
  • Cranial nerve VI palsies
  • Papilledema
  • Periorbital bruising
  • Cushing’s triad
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33
Q

When doing a mental status exam what are the six categories to assess?

A
  • general description
  • emotional state
  • experiences
  • thinking
  • sensorium
  • cognition
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34
Q

What is the Glascow Coma Scale score for coma?

A

Adults < or = to 8

Children < or = to 5

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35
Q

Headache is an early sign of ICP for adults. What are the headache characteristics associated with increased ICP?

A
  • Nocturnal awakening
  • Pain worsened by cough/defication
  • Progressive increase of frequency or severity
  • Vomiting (not proceeded by nausea)
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36
Q

What are the symptoms of increased ICP for infants?

A
  • Irritability
  • Bulging fontanel
  • Lethargy
  • Flat affect
  • Poor feeding

Retinal hemorrhage with increased ICP should raise suspicion of nonaccidental head trauma

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37
Q

At what level of Cerebral Perfusion Pressure is cerebral blood flow compromised and autoregulation impaired?

A

< 60 mmHg

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38
Q

What is the normal rate for cerebral perfusion pressure?

A

between 60 and 70 mmHg

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39
Q

Risk for adult respiratory distress syndrome occurs when CPP level are ______?

A

> 70 mmHg

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40
Q

What is the appropriate CPP level for children?

A

50 to 60 mmHg

Not well established

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41
Q

What are the different pharmacotherapies for intracranial regulation?

A
  • Osmotic diuretics
  • Sedatives
  • Analgesics
  • Antiepileptics
  • Glucocorticoids
  • Antipyretics
  • Anti-hypertensives
  • Anti-Parkinsonians
  • Cholinesterase inhibitors
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42
Q

Which osmotic diuretics are commonly used for intracranial regulation?

A

Mannitol

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43
Q

Which sedatives are commonly used to decrease ICP by reducing metabolic demand?

A
  • Propofol (Diprivan)

- Lorazepam (Ativan)

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44
Q

Which analgesics are used for intracranial regulation?

A
  • Fentanyl (less effects on BP)

- Morphine

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45
Q

Which antiepilectics are used for intracranial regulation?

A
  • Phenytoin (Dilantin)

- Valproic acid (Depakote)

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46
Q

Which glucocorticoids are indicated for cerebra edema related to tumors, abscesses, and CNS infections?

A

Dexamethasone (Decadron)

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47
Q

Which anti-hypertensives are used for intracranial regulation?

A
  • Labetalol (Trandate): 1st choice
  • Transdermal nitroglycerin paste
  • Intravenous Nicardipine (Cardene)
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48
Q

Which Anti-Parkinsonian dopaminergic drugs are used for intracranial regulation?

A
  • Levadopa (Sinemet): most common

Replaces dopamine, increasing the level in the brain. Given with carbidopa which prevents the conversion to dopamine until Levadopa reaches the brain.

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49
Q

Which Anti-Parkinsonian dopamine agonist drugs are used for intracranial regulation?

A
  • Pramipexole (Mirapex)
  • Ropinirole (Requip)
  • Bromocriptine (Cycloset)

These mimic the effect of dopamine by stimulating the same cells as dopamine

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50
Q

Which cholinesterase inhibitors are used for mild to moderate dementia/intracranial regulation?

A
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Reminyl)
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51
Q

Which cholinesterase inhibitors are used for moderate to severe dementia/intracranial regulation?

A
  • Memantine (Namenda)
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52
Q

What is the purpose of a decompressive craniotomy?

A

It removes rigid confines of the skull, allowing for expansion or cranial contents and lowers ICP

Complications include herniation, spinal fluid leak, infection, and hematoma (epidural and subdural)

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53
Q

What is the purpose of a craniotomy?

A
  • remove lesions or tumors
  • repair damages area
  • relieve pressure
  • drain blood from hematoma
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54
Q

What is the purpose of Stereotactic procedures?

A
  • dissection

- biopsy

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55
Q

What is the purpose of Shunt procedures?

A

creates an artificial pathway for excessive CSF to drain from the brain

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56
Q

What is the proper positioning of the head for a patient with ICP?

A
  • HOB 30 degrees

- Head midline

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57
Q

True/False

Patients with ICP should have all nursing care and tasks clustered at once.

A

False
This will increase oxygen demand and may compromise cerebral perfusion. Care and tasks should be distributed over a longer period of time.

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58
Q

True/False

Suctioning of patients with ICP causes no harm and should be performed as needed.

A

False
Suctioning stimulates coughing which increases ICP. If suctioning is absolutely necessary patient may need to be sedated.

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59
Q

True/False

Prophylactic hyperventilation in TBI is not recommended because it increases perfusion.

A

True

This negatively impacts oxygen delivery. This should only be done temporarily to reduce elevated ICP

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60
Q

This is caused by an interruption of perfusion to any part of the brain

A

Stroke

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61
Q

What are the two things the brain cannot store?

A
  • Oxygen

- Glucose

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62
Q

Cerebral tissue death is called an ____

A

infarction

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63
Q

What are the two classifications of stroke?

A
  • Ischemic (occlusive)

- Hemorrhagic

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64
Q

What are the two types of ischemic strokes?

A
  • Thrombotic

- Embolic

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65
Q

This type of stroke is sudden but can be gradual if caused by HTN?

A

Hemorrhagic

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66
Q

With this type of stroke the patient is typically awake?

A

Ischemic

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67
Q

With this type of stroke the patient is typically in a deepened stupor or comatose?

A

Hemorrhagic

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68
Q

What are the two contributing factors for thrombotic stroke?

A
  • HTN

- Atherosclerosis

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69
Q

What is the contributing factor for embolic stroke?

A

Cardiac Disease

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70
Q

What are the two contributing factors for hemorrhagic stroke?

A
  • HTN

- Vessel disorders

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71
Q

This type of stroke usually presents with seizures?

A

Hemorrhagic

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72
Q

In this type of stroke the CSF presents bloody?

A

Hemorrhagic

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73
Q

In this type of stroke the CSF presents normal?

A

Ischemic

Protein may be present with thrombotic stroke

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74
Q

What are the neurologic deficits with thrombotic stroke and when do they present?

A

Deficits during the first few weeks

  • slight headache
  • speech deficits
  • visual problems
  • confusion
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75
Q

What are the neurologic deficits with embolic stroke and when do they present?

A

Maximum deficit at onset

  • paralysis
  • expressive aphasia
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76
Q

What are the neurologic deficits with hemorrhagic stroke?

A

Severe, frequent focal deficits

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77
Q

What is the duration of effects from a thrombotic stroke?

A

Improvements over weeks to months with permanent deficits possible

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78
Q

What is the duration of effects from a embolic stroke?

A

Rapid improvements

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79
Q

What is the duration of effects from a hemorrhagic stroke?

A

Variable recovery with permanent neurologic deficits possible

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80
Q

This type of stroke most often occurs in patients with A-fib, heart valve disease, prosthetic heart valves, or with mural thrombi after an MI

A

embolic stroke

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81
Q

Which type of hemorrhage is caused by sustained HTN ?

A

Intracerebral hemorrhage

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82
Q

Which type of hemorrhage is caused by a ruptured aneurysm, arteriovenous malformation, or trauma?

A

Subarachnoid hemorrhage

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83
Q

This condition occurs during embryonic development and is a tangled collection of malformed, thin walled, dilated vessels without a capillary network?

A

Arteriovenous malformation (AVM)

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84
Q

This is a sudden and periodic constriction of a cerebral artery that often follows a subarachnoid hemorrhage or bleeding from an aneurysm or AVM rupture?

A

Vasospasm

results in reduced perfusion and contributes to secondary cerebral ischemia and infarction

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85
Q

What type of diet is recommended for stroke prevention?

A
  • High fruits/vegetables
  • Low saturated fats
  • Light to moderate alcohol consumption
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86
Q

Which ethnic group has the highest prevalence of stroke?

A
  • American Indian
  • Alaskan Native

Black men/women have higher instance of stroke thn white

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87
Q

What are the modifiable risk factors for stroke?

A
  • Smoking
  • Substance use (particularly cocaine)
  • Obesity
  • Sedentary lifestyle
  • Oral contraceptive use
  • Heavy alcohol use
  • Use of phenylpropanolamine (PPA), found in antihistamine drugs
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88
Q

This type of stroke tends to occur during activity?

A

hemorrhagic stroke

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89
Q

What questions are necessary when a stroke is suspected?

A
  • activity when stroke began
  • how did symptoms progress
  • time symptoms began
  • severity of symptoms (getting better or worse)
  • visual problems
  • gait problems
  • changes with reading/writing
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90
Q

What assessments should be done when a stroke is suspected?

A
  • LOC
  • cognitive/memory impairment
  • difficulties with speech/hearing
  • check for hypoglycemia (w/decreased LOC)
  • o2 saturation
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91
Q

What medical history is important to collect with suspected stroke?

A

History of:

  • HTN
  • Diabetes
  • Heart disease
  • head trauma
  • anemia
  • obesity
  • personal habits (smoking, drug use)
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92
Q

What are symptoms of subarachnoid hemorrhage?

A
  • headache (worst ever)
  • nausea/vomiting
  • photophobia
  • cranial neuropathy
  • stiff neck
  • change in mental status
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93
Q

What are the five most common symptoms of stroke?

A
  • Sudden confusion or trouble speaking or understanding others
  • Sudden numbness or weakness of the face, arm or leg
  • Sudden trouble seeing in one or both eyes
  • Sudden dizziness, trouble walking, or loss of balance/coordination
  • Sudden severe headache with no known cause
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94
Q

To assess cognition changes check for which four signs?

A
  • Denial of illness
  • Spatial and proprioceptive dysfunction
  • Impairment of memory, judgement, or problem solving and decision making abilities
  • Decreased ability to concentrate and attend to tasks
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95
Q

What are the signs of right cerebral hemorrhage?

A
  • Spatial and proprioceptive dysfunction
  • Disoriented to time, place, and person
  • Inability to recognize faces
  • Personality changes such as poor impulse control and poor judgement
  • Impaired sense of humor
  • Loss of depth perception
  • Visual special deficits
  • Neglect of left visual field
  • Impulsiveness
  • Lack of awareness of neurologic deficits
  • Confabulation
  • Euphoria
  • Constant smiling
  • Denial of illness
  • Poor judgement
  • Overestimation of abilities
  • Loss of ability to hear tonal variations
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96
Q

What are the signs of left cerebral hemorrhage?

A
  • Aphasia (inability to use or understand language)
  • Alexia/Dyslexia (reading problems)
  • Agraphia (difficulty with writing)
  • Acalculia (difficulty with math calculations)
  • Possible memory deficits
  • Deficits in right visual field
  • Slowness
  • Cautiousness
  • Anxiety when attempting a new task
  • Depression r/t illness
  • Sense of guilt
  • Feelings of worthlessness
  • Worries over future
  • Quick to anger and feelings of frustration
  • No hearing changes
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97
Q

What are the motor changes that take place with stroke?

A
  • Hemiplegia/Hemiparesis
  • Hemiparesis/Quadriparesis (w/brainstem or cerebellum damage)
  • Hypotonia/Flaccid Paralysis (reduced muscle strength)
  • Hypertonia/Spastic paralysis (contractures)
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98
Q

What are the sensory changes that take place with stroke?

A
  • decreased sensation on affected side
  • Unilateral body neglect (primarily w/right cerebral hemisphere stroke)
  • pupil constriction/dilation
  • ptosis
  • visual field deficits
  • pallor and petechiae of the conjunctiva
  • amaurosis fugax (brief episode of blindness in one eye)
  • hemianopsia (blindness in half of the visual field)
  • nystagmus
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99
Q

What is the name for a brief episode of blindness in one eye?

A

Amaurosis fugax

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100
Q

What is the name for blindness in half of the visual field?

A

Hemianopia

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101
Q

What is the name for blindness in half of the visual field of both eyes (same side)?

A

Homonymous Hemianopia

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102
Q

What is the name for blindness in half of the visual field of both eyes (opposite sides)?

A

Bi-temporal Hemianopia

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103
Q

Patients with this type of stroke may have a heart murmur, dysrhythmias (a-fib), or hypertension

A

Embolic stroke

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104
Q

What is the blood pressure necessary to maintain cerebral perfusion after an acute ischemic stroke?

A

150/100 mmHg

higher pressure may lead to another stroke

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105
Q

A patient who laughs and then cries unexpectedly for no apparent reason suffers from what condition?

A

Emotional lability

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106
Q

Which labs are drawn and what potential lab results are associated with stroke?

A
  • increased H&H (compensation for lack of oxygen)
  • increased WBCs (infection/inflammation)
  • increased cardiac enzymes (if cardiac causes of stoke)
    PT/INR and PTT are requested to establish baseline in the event anticoagulant therapy is needed
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107
Q

What is the purpose of performing a CT without contrast for the possible stroke patient?

A
  • Ischemic or occlusive stroke initially negative, indicating thrombotic or embolic stroke rather than intracerebral hemorrhage
  • Establishes baseline for future CTs
108
Q

What is the purpose of performing an MRI for a possible stroke patient?

A
  • Ischemic brain injury detected earlier than with CT
109
Q

Which EKG findings are typical with stroke patients (and other cardiac diseases)?

A
  • Inverted T-wave
  • ST depression
  • prolonged QT interval
110
Q

What are the priority interventions for a patient experiencing an ischemic stroke?

A
  • Continually assess for ICP
  • Start 2 IV lines
  • Place patient in supine position w/low HOB elevation (25 degrees or less for maximum perfusion/30 degress or more can improve oxygenation and reduce aspiration)
111
Q

What is the drug used to treat acute ischemic stroke?

A

Alteplase (Activase)

112
Q

What is the mechanism of action of Alteplase (Activase)?

A

It is a fibrinolytic that activates plasminogen to degrade the thrombus

113
Q

What is the recommended time interval for administration of Alteplase (Activase)?

A

3 to 4.5 hours

114
Q

What is the administration dosage and administration protocol for Alteplase (Activase)?

A
  • Dosage based on weight
  • 10% of dose given as bolus over 1 minute
  • remainder of dose given over 1 hour
115
Q

What is the recommended endovascular intervention for patients with occlusion of the middle cerebral artery or those past the rtPA window?

A

Intra-arterial thrombolysis

may be given up to 6 hours after onset of stroke

116
Q

What is the recommended treatment for patients who arrive less than 8 hours after stroke?

A 
Mechanical embolectomy
(manual removal of blood clot)
117
Q

When discharging a patient after carotid stent placement, what is the patient education that must be provided with regard to when to call the doctor?

A
  • Severe headache
  • Change in level of consciousness or cognition
  • Muscle weakness or motor dysfunction
  • Severe neck pain
  • Neck swelling
  • Hoarseness or difficulty swallowing
118
Q

This post endovascular procedure complication has a high mortality and morbidity rate?

A 
Hyperperfusion syndrome
(May be associated with intracranial hemorrhage and may occur within 24 hours to 1 week after procedure)
119
Q

What are the signs and symptoms of hyperperfussion?

A
  • severe temporal headache
  • hypertension
  • seizures
  • focal neurologic deficits
120
Q

When is a stroke patient most at risk for increased ICP resulting from edema?

A

during the first 72 hours after onset of stroke

121
Q

How often should patients be assessed after endovascular treatment and stroke?

A

every 1 to 4 hours (depending on condition)

122
Q

What is the first sign of increased ICP?

A

declining LOC

123
Q

True/False

Care of stroke patients should be clustered

A

False

too much activity at one time can cause a dramatic increase in ICP

124
Q

True/False

Stroke patients should be hyperoxygenated before suctioning

A

True

This can avoid transient hypoxemia and result in elevated ICP from dilation of cerebral arteries.

125
Q

True/False

Coughing and suctioning increase ICP

A

True

126
Q

What assessments are important after stroke?

A
  • BP
  • Heart rhythm
  • O2
  • glucose
  • temperature
    Keeping these things in line may prevent secondary brain injury after stroke
127
Q

What are the signs/symptoms of ICP?

A
  • Decreased LOC
  • Behavioral changes (restless, confused, irritable)
  • Headache
  • Nausea/Vomiting
  • Change in speech pattern
  • Pupillary changes
  • Seizures
  • Cushing’s Triad
  • Abnormal posturing
128
Q

These two conditions may present in patients with aneurysm or arteriovenous malformation (AVM)?

A
  • Hydrocephalus (can occur when there is blood in the CSF as this prevents CSF from being reabsorbed)
  • Vasospasm (can result in permanent irreversible neurologic impairment)
129
Q

An initial dose of this medication is recommended within 24 to 48 hours after stroke onset?

A

Aspirin - 325mg

DO NOT give aspirin within 24 hours of rtPA administration

130
Q

This medication crosses the blood brain barrier and treats/prevents cerebral vasospasm after subarachnoid hemorrhage.

A

Nimodipine (Nimotop)

131
Q

What is the mechanism of action for Nimodipine (Nimotop)

A

Relaxes the smooth muscles of vessel walls and reduces incidence and severity of spasms

132
Q

What are the 8 core measures for ischemic stroke care?

A
  1. Venous thromboembolism (VTE) prophylaxis
  2. Discharge with antithrombotic therapy
  3. Anticoagulation therapy for A-fib/flutter
  4. Thrombolytic therapy (for thrombotic stroke of <4 hours from symptom onset)
  5. Antithrombolytic therapy
  6. Discharged on statin therapy
  7. Stroke education
  8. Assessed for rehabilitation
133
Q

This condition is an inflammation of the meninges, specifically the pia mater and arachnoid?

A

Meningitis

134
Q

What are the types of meningitis?

A
  • Viral
  • Bacterial
  • Fungal
  • Protozoal
135
Q

What is the most common type of meningitis?

A

Viral (aseptic)

136
Q

How do the organisms that cause meningitis enter the bloodstream?

A
  • Surgical procedures
  • Penetrating trauma
  • Ruptured abscess
  • Basilar skull fracture (causing CSF leak to drain through nose and ears)
  • Infections (eye, ears, nose, mouth)
137
Q

What are the common viral organisms that cause meningitis?

A
  • enterovirus
  • herpes simplex virus 2
  • varicella zoster virus
  • mumps virus
  • HIV
138
Q

Which type of meningitis typically results in full recovery?

A

Viral meningitis

139
Q

What are the findings in CSF from a lumbar puncture with viral meningitis?

A
  • Clear CSF

- Normal/Slightly elevated glucose

140
Q

Which type of meningitis is a medical emergency and has a high mortality rate?

A

Meningococcal meningitis

death often occurs within 24 hours

141
Q

What are the common bacterial organisms that cause meningitis?

A
  • Streptococcus pneumoniae

- Neisseria meningitides

142
Q

This type of meningitis often occurs in areas with high population density such as dormitories, military barracks, and crowded living areas

A

Meningococcal meningitis

143
Q

What are the findings in CSF from a lumbar puncture with bacterial meningitis?

A
  • Cloudy CSF

- Decreased glucose

144
Q

What is the CDC recommendation for meningococcal vaccination?

A
  • initial dose: ages 11-12
  • booster: age 16
  • Adults should have initial or booster if living a shared residence such as dorms, barracks, group home; traveling to areas where disease is prominent; are immunocompromised
  • safe to receive booster 8 weeks after initial dose
145
Q

What are the clinical manifestations of meningitis?

A
  • Decreased/changed LOC
  • Nuchal regidity
  • Disoriented to person, place, time
  • Photophobia/Phonophobia (light/sound)
  • Nystagmus
  • Short attention span
  • Personality/Behavior changes
  • Hemiparesis/palegia, decreased muscle tone (later)
  • Severe headache
  • Generalized muscle aches and pains
  • Nausea/Vomiting
  • Fever/Chills
  • Tachycardia
  • Maculopapular rash (w/viral meningitis from enterovirus)
  • Petechial rash (w/bacterial from Neisseria meningitis)
  • Seizures (may occur)
  • Bulging fontanel (babies)
146
Q

What type of meningitis causes petechial rash?

A

Bacterial - caused by Neisseria meningitis

147
Q

What type of meningitis causes Maculopapular rash?

A

Viral - caused by enterovirus

148
Q

What is a positive Kernig’s sign?

A

Patient lays supine, when flexing the patient’s hip 90 degrees then extending the patient’s flexed knee, pain is caused

149
Q

What is a positive Brudzinski’s sign?

A

Patient lays supine, flexing of the patient’s neck causes flexion of the patient’s hips and knees

150
Q

What are the complications of meningitis?

A
  • Increased ICP: can lead to herniation of brain and death
  • Seizures: caused when inflammation spreads to cerebral cortex
  • Systemic Inflammatory Response Syndrome (SIRS): reaction to endotoxin produced by infecting bacteria of activation of immune cells… caused rapid decrease in BP, tachycardia, coagulation issues
151
Q

What vascular status assessments should be done by the nurse?

A
  • Color/Temp of extremities
  • Presence of peripheral pulses
  • indicators of abnormal bleeding
  • Capillary refill
152
Q

What tests are done to determine meningitis?

A
  • CT/MRI to determine presence of abscess, hydrocephalus, increased ICP
  • Lumbar puncture for CSF collection
  • Culture/Sensitivity
  • Counterimmunoelectrophoresis (CIE) to determine presence of virus or protozoa (always performed if antibiotic given prior to LP to collect CSF)
  • Urine, throat and nose cultures are collected to perform gram stains to determine bacterial source
  • Xrays of chest, sinuses to determine presence of infection
153
Q

What is the protocol for patient positioning after lumbar puncture?

A

Patient should lie supine and flat for 4 hours post procedure to prevent CSF leak and spinal headache

154
Q

What patient education should be provided to avoid meningitis?

A
  • Vaccinations: MMR, Hib, pneumococcal, varicella

- Thorough hand washing

155
Q

What is the priority intervention for patients with meningitis?

A
  • Accurately monitoring/documenting neuro status (every 4 hours or less if clinically indicated)
156
Q

What are the nursing interventions for a patient with meningitis?

A
  • ABCs
  • Vitals
  • Neuro checks every 2-4 hours
  • Cranial nerve assessment
  • Pain management
  • Vascular assessment
  • Medication/Fluid administration as prescribed
  • Monitor I/Os, manage fluid/electrolyte balance
  • Decrease environmental stimuli
  • HOB elevation at 30 degrees
157
Q

What type of fluids are given for patients with increased ICP?

A

Hypertonic - fluid needs to be removed from cells

158
Q

What is the prophylaxis treatment for those exposed to N. Menigitidis?

A
  • Rifampin (Rifadin, Rofact)
  • Ciprofloxacin (Cipro)
  • Ceftriaxone (Rocephine)
    Rifampin may also be used for prophylaxis fo those exposed to H. influeszae meningitis
159
Q

What type of precautions are used for a patient with bacterial meningitis?

A

Droplet precautions

160
Q

This condition is an inflammation of the brain tissue and often the surrounding meninges. It effects the cerebrum, brainstem, and cerebellum?

A

Encephalitis

161
Q

This type of virus is caused by a bite from a tick or mosquito?

A

Arbovirus

162
Q

What is the common cause of encephalitis?

A

Virus

Also caused by bacteria, fungi or parasites

163
Q

True/False
Viral encephalitis can be life threatening and lead to persistent neurological problems such as learning disabilities, epilepsy, memory deficits or fine motor deficits?

A

True

Quick response to signs and symptoms minimizes the effects of the disease

164
Q

How do meningitis and encephalitis differ?

A
  • Meningitis causes pus formation (exudate)
  • Encephalitis inflammation extends over the cerebral cortex, white matter and meninges, causing degeneration of the neurons of the cortex.
  • Meningitis inflammation extends to the pia mater and arachnoid
  • Most cases of meningitis are recoverable
  • Encephalitis is more life threatening and dangerous
  • Mental status changes are more extensive with encephalitis
165
Q

True/False
Meningitis causes demyelination of axons due to white matter destruction which leads to hemorrhage, edema, necrosis, and development of lacunae

A

False

These are all effects of encephalitis

166
Q

What results in widespread edema with encephalitis?

A
  • Compression of blood vessels
  • Increased ICP
  • Death from herniation and increased ICP
167
Q

What is the incubation period for West Nile Virus?

A

2 to 15 days after being bitten by infected mosquito

168
Q

How is encephalitis transmitted?

A
  • Blood products
  • Breast milk
  • Organ transplant
  • Mosquitos/Ticks
169
Q

What are the diagnostic tests to determine the presence of West Nile Virus?

A
  • Enzyme-linked immunosorbent assay

- West Nile virus-specific immunoglobulin M (IgM) antibody in blood or CFS

170
Q

What are the symptoms of a mild case of West Nile virus?

A
  • fever
  • body aches
  • nausea
  • vomiting
171
Q

What are the symptoms of a moderate/severe case of West Nile virus?

A
  • high fever
  • severe headache
  • decreased LOC
  • tremors
  • vision loss
  • seizures
  • muscle weakness/paralysis
172
Q

How long do the manifestations of West Nile virus persist?

A

Several weeks

Neurological deficits may be permanent

173
Q

What is the most common non-epidemic type of encephalitis?

A

Herpes simplex virus I (HVS1)

Mortality rate for this type are high in comparison to other types of encephalitis

174
Q

What are the common enteroviruses associated with encephalitis?

A
  • Echovirus
  • Coxsackievirus
  • Poliovirus
  • Herpes zoster
  • Viruses that cause mumps and chickenpox
175
Q

Amebic meningoencephalitis is caused by the amebae Naegleria and Acanthamoeba, where are these amoeba found?

A
  • Soil and decaying vegetation
  • Ponds and lakes
    They enter via the nasal mucosa
176
Q

What are the signs and symptoms of encephalitis?

A
  • changes in metal status (agitation)
  • motor dysfunction (dysphasia)
  • Focal neurologic deficits
  • Photophobia/Phonophobia (light/sound)
  • Fatigue
  • Symptoms of increased ICP (decreased ICP)
  • Joint pain
  • Headache
  • Vertigo
177
Q

What are the mental status changes that can take place with encephalitis?

A
  • confusion
  • irritability
  • personality/behavior changes (especially w/herpes simplex)
178
Q

The herpes zoster lesion affects cranial and spinal nerve root ganglia. What are the manifestations?

A
  • Rash
  • Severe pain
  • Itching/Burning/Tingling near innervation of nerves
179
Q

What are the diagnostic tests for encephalitis?

A
  • LP to evaluate CSF
  • Polymerase chain reaction (PCR) test to detect viral DNA or riboneucleic acid (RNA) in CSF
  • electroencephalogram to evaluate brain wave activity and detect seizures
  • CT to determine presence of ICP or obstructive hydrocephalus
180
Q

What is the treatment for encephalitis?

A

Acyclovir (Zovirax) is the antiviral drug used for herpes encephalitis and is most effective when used early in onset

181
Q

When does neurologic decline occur with encephalitis?

A

within 4 to 6 days after initial neurologic symptoms

182
Q

What is the drug therapy for arboviruses and enteroviruses?

A

NONE

183
Q

This is a chronic disorder in which repeated unprovoked seizure activity occurs

A

Epilepsy

184
Q

What is the cause of epilepsy?

A
  • abnormality in electrical neuronal activity
  • imbalance of neurotransmitters (especially GABA)
  • combination of both the above
185
Q

What are the three types of seizures?

A
  • generalized seizures
  • partial seizures
  • unclassified seizures
186
Q

What are the five types of generalized seizures that may occur in adults and involve both cerebral hemispheres?

A
  • Tonic-clonic
  • Tonic
  • Clonic
  • Myoclonic
  • Atonic
187
Q

This type of generalized seizure is an abrupt increase in muscle tone, loss of consciousness, and autonomic changes that last from 30 seconds to several minutes?

A

Tonic seizure

188
Q

This type of generalized seizure causes a sudden loss of muscle tone that lasts for seconds and is followed by a period of confusion. Patients with these seizures often fall causing injury. This type of seizure is resistant to drug therapy.

A

Atonic seizure

189
Q

This type of generalized seizure stiffening or rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness. Rhythmic jerking of all extremities follows. Patient may bite their tongue and become incontinent of urine or feces. Seizures last from 2 to 5 minutes. Fatigue, acute confusion, and lethargy may last up to an hour after this type of seizure.

A

Tonic-Clonic seizure

190
Q

This type of seizure causes brief jerking or stiffening of the extremities that may occur singly or in groups. The last for a few seconds and contractions may be symmetrical or asymmetrical.

A

Myoclonic Seizure

191
Q

This type of seizure causes muscle contraction and relaxation and lasts several minutes.

A

Clonic Seizures

192
Q

This type of seizure begins in part of one cerebral hemisphere and are most often seen in adults and are generally less responsive to medical treatment.

A

Partial Seizures

193
Q

This type of seizure may cause loss of consciousness for 1 to 3 minutes. The patient may wander unaware of the environment at the start of the seizure. There is often a period of amnesia after the seizure.

A

Complex Partial Seizures

Occurs in the temporal lobe and is also called psychomotor or temporal lobe seizures

194
Q

Which type of seizure has symptoms that appear similar to dementia, psychosis, or other neurobehavioral disorders and is therefore difficult to diagnose, especially in the postictal stage (after seizure)

A

Complex partial seizures

195
Q

Which type of seizure often comes with an aura prior to onset?

A

Simple Partial Seizures

196
Q

This type of seizure accounts for half of all seizures and occurs for no known reason

A

Unclassified/Idiopathic Seizures

197
Q

Which drugs should not be given with the antiepileptic drug Phenytoin (Dilantin)?

A

Warfarin (Coumadin)

Grapefruit interferes with metabolism of the drug and can raise the blood level of the drug

198
Q

This condition is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes.

A

Status Epilepticus

199
Q

What are the common causes of status epilepticus?

A
  • Sudden withdrawal of antiepileptic drugs
  • Infection
  • Acute alcohol/drug withdrawal
  • Head trauma
  • Cerebral edema
  • Metabolic disturbances
200
Q

What are the drugs of choice to treat status epilepticus?

A
  • Lorazepam (Ativan)
  • Diazepam (Valium)
  • Phenytoin (Dilantin
201
Q

What are the surgical interventions for epilepsy?

A
  • Vagal nerve stimulation
  • Partial Corpus Callosotomy
  • Partial craniotomy
202
Q

What are the complication of Vagal Nerve Stimulation?

A
  • Hoarseness (common)
  • Cough
  • Dyspnea
  • Neck pain
  • Dysphasia
203
Q

What is the patient teaching after Vagal Nerve Stimulation?

A
  • Avoid MRI
  • Avoid micowaves
  • Avoid shortwave radios
  • Avoid ultrasound diathermy
  • Use magnet when aura presents to avoid seizure
204
Q

Which patients are candidates for conventional surgical procedures for control of seizures?

A
  • Those whose epilepsy/seizures cannot be controlled with medication
  • Those with complex partial seizures in the frontal or temporal lobe
205
Q

This disease is described as a change in the brain that disrupts a person’s interpretation and/or experience of the world secondary to complex neurological changes; hallucinations, delusions and/or disorganized thinking are hallmark characteristics.

A

Psychosis

206
Q

This is a false distortion in perception and can be visual, auditory, gustatory, olfactory, or tactile?

A

Hallucincation

i.e. seeing/hearing things

207
Q

This is a false fixed belief

A

Delusion

i.e. “they’re out to get me”

208
Q

This type of psychosis is reversible and may last from weeks to months

A

Acute psychosis

209
Q

This type of psychosis occurs when symptoms are primarily irreversible

A

Chronic psychosis

210
Q

These two cognitive impairments have rapid onset

A
  • Delirium

- Psychosis

211
Q

This cognitive impairment has slow onset

A

Dementia

212
Q

This cognitive impairment has impaired orientation

A

Dementia - often presents with confusion

213
Q

This cognitive impairment presents with delusions

A

Psychosis

214
Q

With this cognitive impairment speech is incoherent

A

Delirium

215
Q

With this cognitive impairment speech is rapid and pressured

A

Psychosis

216
Q

What are the medical conditions associated with psychosis?

A
  • Brain injury
  • Neurologic disease
  • Hepatic disease
  • Renal disease
  • Autoimmune disease
  • Fluid/Electrolyte imbalance
  • Huntington’s chorea
  • Epilepsy
  • Migraines
  • Hyperthyroidism
  • Hypoxia
  • Hypoglycemia
  • CNS Infections
217
Q

What types of medications are associated with psychosis?

A
  • Analgesics
  • Anticholinergics
  • Anticonvulsants
  • Antihistamines
  • Antihypertensives
  • Antimycrobials
  • Antiparkinsonians
  • Corticosteroids
  • Muscle relaxants
  • GI medications
  • Antidepressants
  • Chemotherapy
  • Disulfiram
218
Q

Psychosis can lead to these changes in functionality/behavior

A
  • Social withdrawal
  • Sleep disturbances
  • Impaired memory
  • Attention deficits
  • Anxiety
  • Decreased motivation
  • Anhedonia
  • Unusual/odd behavior
  • Difficulty with ADLs
  • Diminished sense of smell
  • Decreased stress tolerance
  • Increased sensory activity
219
Q

This stage of HIV presents no AIDS defining illnesses and CD4 T-cell level is 14-28% with a cell count of 200-499

A

Stage II

220
Q

This stage of HIV presents AIDS illnesses and CD4 T-cell level is less than 14% with a cell count <200

A

Stage III

221
Q

This stage of HIV presents with HIV infection and AIDS illness and no info regarding CD4 T-cells

A

Stage IV

222
Q

This stage of HIV presents no AIDS defining illnesses and CD4 T-cell level is 29% or higher and a cell count of 500 or higher

A

Stage 1

223
Q

What is the goal of HIV management?

A

Keep viral load low and Medication load high

224
Q

This enzyme converts HIV’s single stranded RNA into double stranded DNA

A

Reverse Transcriptase

225
Q

What drug class prevents the HIV retrovirus from converting from single stranded RNA to double stranded DNA

A
  • Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

226
Q

This enzyme allows HIV DNA to infiltrate the nucleus of the CD4 t-cell

A

Integrase

227
Q

What drug class prevents the HIV retrovirus DNA from infiltrating the nucleus of the CD4 T-cells

A

Integrase Inhibitors (IIs)

228
Q

This HIV enzyme allows the protein strand to be broken

A

Protease

229
Q

What drug class prevents the HIV enzyme protease from breaking protein strands

A

Protease Inhibitors (PIs)

230
Q

What are the risk factors that can effect the rate of progression for AIDS?

A
  • Frequent re-exposure to HIV
  • Presence of other STDs
  • Nutritional status
  • Stress
  • Non-adherence to medication protocol
231
Q

What is the timeframe for acute HIV infection development after being infected?

A

Some within 4 weeks

232
Q

What are the manifestations of acute HIV infection?

A
  • Fever
  • Night sweats
  • Chills
  • Headache
  • Muscle aches
  • Sore throat
  • Rash
233
Q

What are the immune system abnormalities that occur with poor CD4 T-cell function?

A
  • Lymphocytopenia
  • Increased production of incomplete/non-functional antibodies
  • Abnormally functioning macrophages
234
Q

What is the most common cause of death for those with HIV, other than AIDS?

A

Opportunistic infection

235
Q

What is the timeframe from the beginning of HIV infection to the development of AIDS

A

Ranges from months to years

236
Q

How is AIDS most commonly transmitted?

A

Male-to-Male sexual encounter

237
Q

What are the modes of transmission for AIDS?

A
  • Male-to-Male sexual encounter
  • Exposure to semen/blood of infected individual
  • Parenterally (needle stick, transfusion)
  • Perinatally (infant exposure to blood/vaginal secretions or breast milk
238
Q

Most new cases of HIV occur in which ethnic groups?

A
  • African American

- Hispanic

239
Q

What are the ABCs of safe sex to prevent HIV/AIDS?

A

A - Abstinence
B - Be faithful
C - Condom use

240
Q

How is HIV most often sexually transmitted?

A
  • Genital
  • Anal
  • Oral
    Any mucous membranes exposed to infected semen, blood or vaginal secretions
241
Q

Which body fluids can carry the HIV virus?

A
  • Blood
  • Semen
  • Vaginal secretions
  • Breast milk
  • Amniotic fluid
  • Urine
  • Feces
  • Saliva
  • Tears
  • CSF
  • Lymph nodes
  • Cervical cells
  • Corneal tissue
  • Brain tissue
242
Q

HIV is more easily transmitted between these two types of individuals?

A

Infected male and uninfected female

243
Q

What condition presents in HIV+ females?

A

Irregular menses

244
Q

What condition presents in HIV+ males?

A

Low testosterone

245
Q

What are the immunologic manifestations of AIDS?

A
  • Low WBCs (CD4 ct <200)(CD4/CD8 ration <2)
  • Hypergammaglobulinemia
  • Opportunistic infections
  • Lymphadenopathy
  • Fatigue
246
Q

What are the integumentary manifestations of AIDS?

A
  • Dry skin
  • Poor wound healing
  • Skin lesions
  • Night sweats
247
Q

What are the respiratory manifestations of AIDS?

A
  • Cough

- Shortness of breath

248
Q

What are the GI manifestations of AIDS?

A
  • Diarrhea
  • Weight loss
  • Nausea/Vomiting
249
Q

What are the CNS manifestations of AIDS?

A
  • Confusion
  • Dementia
  • Headache
  • Fever
  • Visual changes
  • Memory changes
  • Personality changes
  • Pain
  • Seizures
250
Q

What are the opportunistic viral infections common with AIDS?

A
  • Cytomegalovirus
  • Herpes
  • Varicella-zoster
251
Q

What are the opportunistic bacterial infections common with AIDS?

A
  • Mycobacterium avium
  • TB
  • Nocardiosis
252
Q

What are the opportunistic fungal infections common with AIDS?

A
  • Candidiasis
  • Pneumonia
  • Cryptococcosis
  • Histoplasmosis
  • Coccidioidomycosis
253
Q

What are the opportunistic protozoal infections common with AIDS?

A
  • Toxoplasmosis
  • Cryptosporidosis
  • Isosproiasis
  • Microsporidosis
  • Strongyloidiasis
  • Giardiasis
254
Q

What is the most common opportunistic infection for people with HIV?

A

Pneumocystis Jiroveci pneumonia (PCP)

255
Q

What is the infection contracted through cat feces or ingesting undercooked meat?

A

Toxoplasmosis encephalitis

256
Q

What is the infection that results in a loss of fluids of up to 15 to 20 L/day and ranges from mild diarrhea to severe wasting with electrolyte imbalance?

A

Cryptosporidiosis

Assess for unplanned weight loss of 5 pounds or more

257
Q

What are the malignancies associated with weakened immune systems?

A
  • Kaposi’s sarcoma
  • Lymphoma
  • HPV
258
Q

What are the endocrine complications that may present with HIV?

A
  • Gonadal dysfunction
  • Decreased body muscle mass
  • Decreased weight
  • Decreased libido
  • Decreased energy
  • Fatigue
  • Body shape changes (buffalo hump)(from PIs & NRTIs)
259
Q

Which HIV drug causes higher incidence of type 1 diabetes and hyperlipidemia?

A

PIs

260
Q

What is the normal ration of CD4:CD8 cells?

A
  • 2:1

With HIV/AIDS CD4 levels decrease while CD8 levels remain normal

261
Q

What is the normal WBC count

A

-5,000 to 10,000

With HIV/AIDS levels drop (often as low as 3500)

262
Q

What should the diet be for a person with HIV/AIDS?

A
  • High calorie
  • High protein
  • Drink 2-3 L/day
263
Q

What happens to hematocrit and hemoglobin levels if shock is caused by poor clotting and hemorrhage?

A

Levels will decrease

264
Q

What happens to hematocrit and hemoglobin levels if shock is caused by dehydration or fluid shift?

A

Levels will increase

265
Q

What is the period of time which TIA symptoms typically resolve?

A

30-60 minutes

266
Q

This is a sudden and periodic constriction of a cerebral artery and often follows subarachnoid hemorrhage or bleeding from an aneurysm or AVM rupture?

A

Vasospasm

267
Q

The standard of practice for this type of stroke is to start two IV lines with non-dextrose isotonic saline

A

Ischemic stroke

Med Surg III - 2320 (3 decks)

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