Eye/ear/neuro Flashcards

Question

The clinic nurse notes that following several eye examinations, the physician has documented a diagnosis of legal blindness in the client’s chart. The nurse reviews the results of the Snellen’s chart test expecting to note which of the following? A. 20/20 vision B. 20/40 vision C. 20/60 vision D. 20/200 vision

Answer 1

A Betal blockers Alpha blockers Miotics Carbinc anhydrase inhibitors

Answer 2

D. You want to speak directly facing the client, in a clear concise voice, do not yell

Answer 3

A, C, D, E A.green leafy veggie C. Source of zinc D. vitamin C E. beta carotene

Answer 4

judgement, personality, inhibition Dysfunction: no filter, expressive aphasia (broca), poor judgement, etc

Answer 5

memory and sound, understanding of language Dysfunction: receptive aphasia (wernicke), memory and speech issues

Answer 6

sensory, space analytics, spatial awareness Dysfunction: decreased/loss of sensations

Answer 7

visual perception Dysfunction: irregular vision

Answer 8

Motor: Weakness to paralysis Muscle spasticity Sensory: numbness/tingling Partial blindness/blurred vision Decreased hearing Cerebellar: Nystagmus Dysphagia Ataxia Others: Fatigue bowel/bladder changes Sexual disturbances + Lhermitte's Sign Flex neck to chest, will have shocking sensation down spinal cord Symptoms decrease during pregnancy but during postpartum women are at greater risk for disease exacerbation.

Answer 9

No Definitive Diagnostic test History & Physical Clinical manifestations CSF analysis: Increased IgG Decreased evoked potential response CT & MRI: sclerotic plaque- vital

Answer 10

NO CURE Decrease Inflammation: Prednisone and ACTH Decrease Autoimmune Attack: immunosuppressants, immunomodulators, monoclonal antibodies Symptom Management: muscle relaxants Surgery Avoid Triggers

Answer 11

Promote Independence Manage symptoms Optimal nutrition Prevent complications Help identify and avoid triggers Provide resources for mental health

Answer 12

Definition: chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia/akinesia), increased muscle tone (rigidity), tremor at rest, and gait changes TRAP T: Tremor R: Rigidity A: Akinesia Postural Instability Cause: decrease in dopamine producing neurons in the substantia nigra

Answer 13

EARLY: Slight limp Slight tremor Decrease in arm swing LATE: Pill rolling Aggravated by stress Worse at rest Rigidity: resistance to passive movement through ROM Bradykinesia Stooped shoulders Masked expression Shuffling gait Drooling- aspiration Slow, monotonous, slurred speech Little, if any arm swing

Answer 14

MEDS Levodopa/Carbidopa (Sinemet) Levodopa: chemical precursor of DA Carbidopa: prevents breakdown of levodopa before it reaches brain Dopamine Receptor Agonists (Requip, Mirapex): directly stimulate DA receptors Dopamine Agonists (Amantadine): Blocks NMDA-type glutamate receptors, increases dopamine release, and blocks dopamine reuptake SURGERY Deep brain stimulator

Answer 15

Promote exercise Promote Self care Promote optimal speech Bowel regimen Nutrition Aspiration risk HOB elevated, sit upright Maintain body weight Fall risk Drooling Give atropine 1% solution -If they are in a soft recliner, they will have a harder time getting out. Protein at night and meds in the morning

Answer 16

Definition: autoimmune disease of the neuromuscular junction marked by fluctuating weakness of certain skeletal muscle groups Antibodies attack ach receptors decreases the number of Ach receptors available Weakness increases with muscle use Thought to be started by viral infection

Answer 17

Early muscle fatigue that gets better with rest Muscles affected: eyes, eyelids, chewing, swallowing, speaking, and breathing Muscle weakness is worse by the end if day Complications Aspiration Respiratory insufficiency Respiratory infection Hallmark: muscle weakness becomes worse with activity and better with rest

Answer 18

Eyelid droop Tensilon test: Electrically stimulate hand EMG shows muscle fatigue Tensilon is injected If muscle improves the patient is positive for MG

Answer 19

Medications Anticholinesterase (Pyridostigmine): prolongs the action of ACh and improves impulse transmission at the neuromuscular junction Peaks 1 hour after give, schedule nutrition/activity accordingly Corticosteroids: suppress immune response Immunosuppressants: suppress immune Plasmapheresis Removes plasma from blood to remove anti-ach receptor antibodies Short term benefits Used before surgery Used for crisis Surgery Removal of thymus gland Can also give IgG as well

Answer 20

Respiration precaution: educate about choking risk Optimal nutrition Small meals, easy to chew Thicken liquids Schedule meals with peak times of meds Optimal communication Self esteem

Answer 21

An overarching name for a variety of disorders Alzheimer's is the most common form of dementia Other forms Vascular: infarcts from fatty plaques Mixed types Systemic Etc Symptoms Memory impairment Aphasia Lose short term memory, later lose long term memory

Answer 22

Multifactorial causes believed to be genetics and other factors (cardiovascular health, diabetes, head trauma, environment, abnormal brain proteins, etc) Characteristics High concentration of beta-amyloid plaques Neurofibrillary tangles seen on postmortem exam Cannot diagnose alzheimer's until postmortem exam

Answer 23

Diagnosis by exclusion until time of autopsy Meds Cholinesterase inhibitors (memory) Serotonin reuptake inhibitors (depression) Antipsychotics (behavioral) Sleeping aids Nursing Risk of injury Coping for patient and family Self esteem Self care Caregiver burden

Answer 24

Intracranial Pressure

Answer 25

Change in LOC Change in VS Watch for Cushing's Triad Bradycardia with bounding pulse Systolic HTN with widening pulse pressure Irregular respiratory pattern Occular signs (doll eyes) Ipsilateral: same side as injury Contralateral: opposite side of injury Acidotic Decreased motor function Headache Vomiting greater than 30 is herniation of brain stem

Answer 26

CT & MRI NO lumbar puncture, because it would add to the pressure Treatment: tx underlying cause Meds: Osmotic diuretics (mannitol) redistributes the volume Corticosteroids (decadron)

Answer 27

HOB 30 degrees Maintain airway and oxygenation Avoid anything that would increase ICP (stimulation) Nutrition Monitor skin integrity Monitor for infection Dark environment, no tv, no music Do not cluster care, could be too much for patient, so monitor ICP while caring for patient Prevent increase intraabdominal pressure (laxatives, cough suppressants if needed)

Answer 28

C. pyridostigmine peaks one hour after given

Answer 29

C. Small meal easy to chew for fatigued muscles

Answer 30

B they have the most energy in the morning

Answer 31

Diplopia is a neurological symptom that can occur from ms

Answer 32

A Patients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.

Answer 33

D The patient with Parkinson’s disease would be instructed regarding safety measures in the home. The patient needs to use a walker as support to get to the bathroom because of bradykinesia. The patient would sit down to put on pants and shoes to prevent falling. The patient needs to exercise every day in the morning when energy levels are highest. The client needs to have all loose rugs in the home removed to prevent falling.

Answer 34

D. Normal ICP is 5-15

Answer 35

D (CUSHINGS)

Answer 36

Intracranial Pressure (ICP): the hydrostatic force measured in the brain CSF compartment Normal: 5-15 Cerebral Perfusion Pressure (CPP): the pressure needed to ensure blood flow to the brain Normal : 60-100 Calculation: MAP-ICP <30 is incompatible with life: risk for herniation 50 is a critical value CPP is vital to the brain because the brain does not store oxygen or glucose.. it requires a constant supply

Answer 37

Signs/Symptoms Battle sign: postauricular ecchymosis Raccoon eyes: periorbital ecchymosis Fracture is associated with a tear in the dura, this leads to CSF leak (rhinorrhea, otorrhea) Assessment Evidence of break of fall Obtain VS, cross and match blood Halo sign: clear nasal drainage or drainage from ear: on a gauze, blood will pull to center with yellow surrounding it (evidence of CSF) Presence of glucose on Tes-tape reading Ask about antiplatelets meds (aspirin, warfarin, clopidogrel) Nursing Care If you see if happen: quickly apply direct pressure or ice to stop bleed Avoid NG tube** Fluids/blood

Answer 38

Definition: a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC Sudden change in LOC with or without loss of consciousness Signs/Symptoms HA Amnesia to the event Disruption in level of consciousness Post Concussion Syndrome Can develop 2 weeks to 2 months after injury S/S Personality changes Behavioral changes Decreased attention span Decreased ability to recall short term memory Change in intellectual ability Assessment: Ask about headache Ask them to remember 3 words Count backwards from 100 to 75 Ask about the number of concussions the patient has had Patient has to be one week headache free to be cleared!

Answer 39

Contusion: bruising of the brain Can have a fracture, edema, necrosis at site Coup-contrecoup: After the head strikes the wall, a coup injury occurs as the brain strikes the skull (primary impact). The contrecoup injury (the second impact) occurs when the brain strikes the skull surface opposite the site of the original impact. Can have seizure post injury Lacerations: tearing of brain tissue Causes bleeding which is very damaging to brain due to the pH of blood ask ABOUT ANTICOAGULANTS USE

Answer 40

Epidural Hematoma: bleeding between dura and inner surface of the skull ARTERIAL BLEED—> Neuro Emergency: will need a craniotomy Hallmark sign: patient loses consciousness, wakes up, rapidly declines! Subdural Hematoma: bleeding between the dura mater and the arachnoid layer covering the brain Venous bleed: presents 24-48 hours after the injury is present. Sometimes can reabsorb itself Intracerebral bleeding: bleeding within the parenchyma

Answer 41

Get patient to CT to find out what is going on! Pain management No narcotics bc it can change the neuro exam Observe for fever Neuro Checks GCS Pupil Response Monitor for sensory function Keep ICP down

Answer 42

Thrombotic Stroke: clot forms because of vessel wall injury Embolic: embolus travels to cerebral artery d/t secondary issue such as afib (cardiac) Treatment: Aspirin TPA/Fibrinolytic therapy must be given within 3 to 4 hours of the onset of signs of ischemic stroke Cerebral angiography (funds tumor) Merci Retriever (removes clot) Most important thing we need to know is when symptoms start occuring What are some questions we need to ask before giving TPA?

Answer 43

Intracerebral: bleeding within the brain caused by a rupture of a vessel HTN is most common cause Sudden onset of symptoms Subarachnoid hemorrhage: occurs when there is intracranial bleeding into the cerebrospinal fluid (CSF)–filled space between the arachnoid and pia mater membranes on the surface of the brain Rupture of cerebral aneurysm “Worst HA of my life” Risk for vasospasm Treatment: Evacuate bleed Clip or coil aneurysm Ligate bleed Permissive HTN

Answer 44

After a subarachnoid repair, we allow HTN in order to prevent a vasospasm to occur This allows increased blood flow to cerebral tissue HHH Therapy to prevent Vasospasm Hypertension Hypervolemia Hemodilution CCB IV (vasodilates)

Answer 45

Sudden confusion Sudden difficulty understanding or speaking Sudden loss of vision out of one eye Sudden severe headache Sudden weakness of the face, arm, or leg, especially affecting one side of the body Warning Signs use: FAST Face drooping Arm weakness Speech difficulties Time Communication Broca’s: expressive aphasia Wernicke's: receptive aphasia Global: expressive and receptive aphasia

Answer 46

Time is MONEY ABC’s! CT Stat If ischemic: tpa within 3-4.5 hours Meds: antiplatelet and anticoagulant if ischemic OT/PT/Speech Respiratory and cardiac monitoring Skin care BP control Nutrition Bowel/Bladder care Appropriate environment temp and safety

Answer 47

Acute inflammation of the lining of the brain and spinal cord Manifestations Fever Severe headache Nuchal rigidity Photophobia N/V if bacterial Viral=Victory Clear CSF Bacterial=Bad → Medical Emergency!! Cloudy CSF

Answer 48

Is suspected: Get blood culture and CT scan Diagnosis is verified by a Lumbar Puncture Lateral recumbent position Seated forward AVOID if ICP is increased Make sure patient voids before

Answer 49

Cranial Nerve 5: Trigeminal Symptoms: Sudden pain- knifelike often in lips, cheek, forehead Twitching, blinking Precipitates by cold/hot sensation, chewing, brushing teeth Can be unpredictable pain Treatment: Mediation Tegretol: decreases during of nerve Surgery Nursing Stress management Total Nutritional Intake** Self image changes Monitor for med side effects

Answer 50

Definition: Acute, usually temporary, facial paresis (or palsy) resulting from damage or trauma of the facial nerve (CN VII) Usually affects one side but can affect both Etiology: unclear, maybe from herpes simplex virus Diagnostic: by exclusion Symptoms: Flaccid face on affected side with drooping mouth and drooling Unable to close eyelids with an upward movement of eyeball Flattening of nasolabial folds Unilateral loss of taste Decreased ability to chew Very painful

Answer 51

Nursing: Gentle massages, moist heat Pain management Aspiration Precaution Corneal Abrasion risk Check in with patient for depression/body image Treatment Corticosteroids immediately Acyclovir if HSV is the cause

Answer 52

Neurological illness characterized by ascending symmetrical paralysis Unknown etiology Characteristics: 1-3 weeks following a URI or GI infection Distal muscles begin to become weak and spreads up toward the diaphragm Paresthesia usually followed by paralysis Complications Respiratory infection or UTI Respiratory insufficiency DVT, paralytic ileus, PE malnutrition

Answer 53

Complete: Total loss of motor and sensory below level of injury Incomplete Cord Lesion: some tracts are spread, so there is partial function restored Brown Sequard Syndrome**: damage to half of cord. Contralateral (opposite side of injury): Loss of pain and temperature sensation below level of injury Ipsilateral (same side as injury): Loss of motor function, light touch, pressure, position, and vibratory sense

Answer 54

Pain management Prevent UTI Prevent respiratory infection Prevent contractures Nutrition! OT/PT Temperature and safety Family counseling Body Image/Self esteem Autonomic Dysreflexia: A massive, uncompensated cardiovascular reaction mediated by the SNS Elevate HOB 45 degrees and determine cause Most common cause is bladder irritation→immediate catherization

Answer 55

Severe infection of the nervous system affecting spinal and cranial nerves Usually from skin wound contaminated with Clostridium tetani (found in soil) Produces neurotoxin in body that causes tonic muscle spasms Fever, stiffness in jaw and neck that progresses throughout body Adults should receive a tetanus q 10 years

Answer 56

C- no NG tube for basilar skull fracture!!

Answer 57

C Decerabate posturing is characterized by the rigid extension and pronation of the arms and leg

Answer 58

C. hallmark of epidural hematoma. MEdical Emergency What does this patient need? Craniotomy

Answer 59

C. A CT scan will determine if the client is having a stroke or has a brain tumor or another neurological disorder

Answer 60

C. Pt most likely has increased ICP

Answer 61

C The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client’s condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.

Answer 62

ABD Hemiparesis is a weakness of one side of the body that may occur after a stroke. It involves weakness of the face and tongue, arm, and leg on one side. These clients are also aphasic, unable to discriminate words and letters. They are generally very cautious and get anxious when attempting a new task. Complete bilateral paralysis does not occur in hemiparesis. The client with right-sided hemiparesis has weakness of the right arm and leg and needs assistance with feeding, bathing, and ambulating.

Answer 63

Visual Acuity 20/20. No diplopia (double vision) External eye structures symmetric and without lesions or deformities Lacrimal apparatus non-tender without lesions or deformities Conjunctiva clear; sclera white PERRLA Lens Clear Optic disc margins sharp Retinal vessels without AV nicking, with no hemorrhages or spots Extraocular muscles Intact