FINAL EXAM Study Guide Version Part 2 Flashcards
What different tests are done when a patient comes into the hospital with a fever of unknown origin? In other words, what is a septic panel of tests?
CBC, Chem 25, Urinalysis, CMP, Lumbar Puncture, CT (so a shotgun workup..)
Blood culture on two different arms
UTI, Pneumonia, Meningitis (Common sources)
Recognize the signs and symptoms of compartment syndrome and what to do about it.
Compartment Syndrome (Muscles expand, pushes against nerves and arteries) EMERGENCY → fasciotomy
- CUT THAT LEG OPEN, its pretty brutal
- pain is unrelieved by anything
OSTEOPOROSIS
Osteoporosis: Its in the name lol, Porous bones, brittle bones
Med management
- Nutrition and Exercise
- Calcium + Vitamin D
- Boniva + Fosamax (Don’t eat or drink for 30 mins after med) Stand up during this time.
Nurse management:
- Education, keep patient safe, fall precaution.
OSTEOARTHRITIS
Slowly progressive non-inflammatory degeneration of articular cartilage, usually affecting the weight bearing joints- spine, knees, hips.
Med Management:
- Tylenol
- NSAIDs
- Corticosteroid injections
- Joint replacement
Nurse Management:
- Nutrition plus lose weight
- ADL’s
- ROM
- Home safety and point protection
- Non-Pharm stuff like ice packs
ISCHEMIC STROKE
Result of plaque formation and blood clots that causes the narrowing of the lumen of a blood vessel. When the blood vessel occludes completely infarction occurs - BAD!
HTN and DM → atherosclerotic disease → plaque buildup → stroke
1st thing to do - CT scan because quick to figure out what kind of a stroke pt has
- Pts receive TPA to break up the clot and to restore blood flow
- TPA can only be given in a 4 hour window from when the symptoms started
- CI of TPA: hematological disorder, systolic BP >200, recent surgery (within 3 months), recent GI bleed, recent CPR, recent head trauma, pregnancy (case by case)
- Make sure benefits of TPA outweigh the risks
- Pt on Coumadin - we must reverse the Coumadin with fresh frozen plasma IV and Vit K subq
- If patient is on Xarelto, Pradaxa, elequis - there is no treatment becasuse these blood thinners are non-reversable
ISCHEMIC STROKE
MEDICAL MANAGEMENT
1st thing - ABC’s!!!!!!!!
- Endotracheal intubation and mechanical ventilation if necessary
- Thrombolytic therapy (tPA), within 3 hours of onset
- Anticoagulation therapy, IV fluids
- ASA therapy - chew
- Cardiac monitoring - watch for atrial fib
- GI decompression - NGT - no bowel sounds
- Activity- bedrest and passive ROM, fall precautions
- Nutritional support- Enteral feeding tube or TPN
- Swallow precautions: aphasia may cause aspiration
- Antihypertensive medications: Nitrates- NTG
- Histamine 2 blocker antagonists: Pepcid - start right away to prevent stress ulcers
- Anticonvulsants: Dilantin - SE: gingival hyperplasia (see dentist every 6m)
- Glucocorticoid: dexamethasone - Decadron - decreases inflammation
- Indwelling urinary catheter
- Seizure precautions - side rails up with padding
- Monitoring vital signs: ICP (1st sign of increasing ICP is LOC), neurovitals
- Osmotic diuretics: Mannitol - decreases water levels in brain
- Occupational, physical, and speech therapy
- Labs:
- CBC - monitor elevated WBC - infection
- Electrolytes - make sure K+ >4 and MG++ >2
- ABG’s - check pH
- PT, PTT - monitor for bleeding
- Diet: Low Na+, Increased K+, Low cholesterol - know for exam
ISCHEMIC STROKE
NURSING MANAGEMENT
- Semi-Fowlers position to decrease pressure and swelling, we want to keep patients brain higher than the body
- Maintain diet as ordered
- O2 and fluids
- Maintain position, patency, and low suction of the NG tube
- Maintain and record vitals signs, neurovitals, labs, and oxygen status
- Swallow precautions, fall precautions, supportive care
- Carotid ultrasound - to see how much blockage
HEMORRHAGIC STROKE
Bleeding into the brain tissue, the ventricles, or the subarachnoid space
- Higher mortality
- May be due to spontaneous rupture of small vessels primarily related to hypertension; subarachnoid hemorrhage due to a ruptured aneurysm; or intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations (AVMs), intracranial aneurysms, or medications such as anticoagulants
- ICP increases when there is blood in the subarachnoid place
- Manifestations:
- Severe headache, early and sudden LOC, vomiting w/o feeling nauseous
HEMORRHAGIC STROKE
MEDICAL MANAGEMENT
- Control of hypertension: bring BP down gradually - 20% per 24 hour period, don’t want to being BP too low too fast
- Diagnosis: CT scan (fastest), cerebral angiography, and lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage
- Care is primarily supportive - bec nothing we can do
- Bed rest with sedation
- Oxygen
- Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
HEAD TRAUMA
Classified by type of fracture, hemorrhage, or trauma to the brain
Fractures: depressed, comminuted, linear, basal skull fracture
Hemorrhages: epidural, subdural, intracerebral, subarachnoid
Trauma: concussion or contusion (brusing to brain)
Brain injury results in edema or hypoxia
HEAD TRAUMA
CLINIAL MANIFESTATIONS
- Disorientation to time, place, or person
- Paresthesia
- Positive Babinski’s reflex
- Decreased LOC - 1st sign
- Ottorrhea & Rhinorrhea - signs of CSF leakage
- Clear fluid is tested with litmus paper for glucose, if (+) then it is CSF
- Unequal pupil size and loss of pupil reaction
CEREBRAL ANEURYSM
Definition: Dilation or localized weakness of the middle layer of an artery
- Cerebral aneurysms usually arise at arterial bifurcations in the Circle of Willis and it’s branches.
- Classified by type: Saccular (berry), Fusiform, Mucotic
- Causes: atherosclerosis, trauma, congenital weakness, syphilis
- Patho: enlargement of aneurysm compresses nerves; enlargement will finally result in dissolution of the wall and rupture the aneurysm; rupture results in subarachnoid hemorrhage
- Assessment findings: diplopia, ptosis, severe headache, hemiparesis, nuchal rigidity, decreased LOC, seizure activity, vomiting, blurred vision
CEREBRAL ANEURYSM
MEDICAL MANAGEMENT
- IV therapy: fluids if needed
- Oxygen therapy to keep Sv02 > 95 %
- Position: semi-Fowlers; Activity: bedrest
- Monitoring: VS, telemetry, ICP, neuro VS, arterial line
- Precautions: seizure and aneurysm bleed, rupture
- Anticonvulsants: Dilantin
- Glucocorticoid: Decadron
- Histamine antagonists: Pepcid, Zantac
- Antihypertensives: Hydralazine (Apresoline)
- Intubation and mechanical ventilation if needed
- Antifibrinolytic: Amicar
CEREBRAL ANEURYSM
NURSING MANAGEMENT
- Administer fluids; maintain saline lock
- Monitor VS, Neuro vitals, intake and output, O2
- Maintain quiet, calm environment, allay fears, anxiety
- Assess headache pain; Prevent Valsalva’s maneuver; prevent constipation
- Assess for signs of increased ICP, meningeal irritation
- Maintain seizure and aneurysm precautions
- Alter ADL’s to compensate for neuro deficits
SEIZURES
Involuntary muscle contractions caused by paroxysmal, uncontrolled discharge of electrical impulses from nerve cells; neurons firing asynchronously
Causes of seizures:
Idiopathic, Head injury, SLE, DM, Hypoglycemia, metabolic disturbances, Brain tumor, hypertension, Infection, septicemia, dehydration, Anoxia, alcohol and barbiturate withdrawal
SIMPLE PARTIAL SEIZURE
Simple partial: consciousness remains intact; patients do not lose posture, and do not lose consciousness, may stare off into space (little kids staring off in classrooms example)
SIMPLE PARTIAL- symptoms confined to one hemisphere→ May have motor (change in posture), sensory (hallucinations), or autonomic (flushing, tachycardia) symptoms; No loss of consciousness.
COMPLEX PARTIAL SEIZURE
Complex partial: patient partially or completely loses consciousness
COMPLEX PARTIAL- Begins in one focal area, but spreads to both hemispheres→ Loss of consciousness, aura of visual disturbances; post-ictal symptoms
ABSENCE (PETIT MAL)
GENERALIZED SEIZURES
Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.
ABSENCE (PETIT MAL):
- Sudden onset; lasts 5-10 seconds
- Can have 100 daily w/o people realizing
- Precipitated by stress, hyperventilation, hypoglycemia, fatigue, flashing lights
- Differentiated from daydreaming
SYMPTOMS: Loss of responsiveness, but continued ability to maintain posture control, Staring spell, Twitching eyelids, Lip smacking, No post-ictal symptoms
TONIC-CLONIC (GRAND MAL)
GENERALIZED SEIZURE
Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.
Grand-mal -
- Major motor seizure activity
- Violent total body seizure; both sides of brain
SYMPTOMS: Aura then loss of consciousness and falling, Tonic (stiffening of the body) first (20-40 seconds) then clonic (jerking of the extremities) after; Cyanosis, tongue or cheek biting, excessive salivation and incontinence may occur; Post-ictal symptoms: patient has no memory of the seizure
ATONIC SEIZURE
GENERALIZED SEIZURE
Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.
ATONIC SEIZURES:
- Drop and fall attack
- Patient needs to wear protective helmet at all times- hard to be compliant
SYMPTOMS: Loss of posture tone, Loss of consciousness
UNCLASSIFED SEIZURES
FEBRILE
- Seizure threshold lowered by elevated temperature.
- Only one seizure per fever
- Common in 4% of population under age 5; tend to occur in small children that have very high fevers
- Occurs when temperature is rapidly rising
SYMPTOMS: Lasts less than 5 minutes, Generalized, transient, and non-progressive; Doesn’t generally result in brain damage; EEG is normal after 2 weeks
SEIZURE PHASES
Prodromal phase: signs or activity that precede a seizure. Patient may or may not be aware.
Aural phase: A sensory warning that precedes a seizure
Ictal phase: Full seizure; patients will have the tonic (stiffening) & clonic (muscle contractions)
Post-ictal phase: period of recovery after a seizure. Patient may be very lethargic and fatigued. (can sleep 10-12 hours)
(phase 1 & 2 do not happen for all people)
NOTE: THE CANINE IMAGE IS A GREAT REPRESENTATION OF THE HUMAN PHASES
STATUS EPILPTICUS
Prolonged or frequent repetition of seizures without interruption
- Results in anoxia; Can cause cardiac and respiratory arrest
- May be fatal !!!!!
- Tonic-clonic status epilepticus is most dangerous because it can cause acidosis, arrhythmias, resp arrest.
- Consciousness not regained between seizures
- Lasts more than 30 minutes
- May involve any type of seizure
- Permanent brain damage may result; Neurological emergency
- Patients given big doses of Valium- start with 10 mg IV push and go up from there; have to quiet the brain down→ give benzos followed by anti-seizure med
- Assessment findings: loss of consciousness, dyspnea, fixed and dilated pupils, incontinent of bowel and bladder
STATUS EPILEPTICUS
DIAGNOSTIC TEST FINDINGS
EEG: abnormal wave patterns, focus of seizure activity
CT scan: a space-occupying lesion
MRI: pathologic changes
Brain mapping: identification of seizure areas; possible ablation of foci
STATUS EPILEPTICUS
MEDICAL MANAGEMENT
- Monitor V.S., I/O, and neurovital signs; Activity: bedrest; seizure precautions; Diet: General
- IV therapy: fluids as needed
- Labs: Glucose, electrolytes, anticonvulsant drug levels
Meds: Anticonvulsants: Depakote,Tegretol, Dilantin, Zarontin, Luminal, Neurontin, Lamictal, Topomax
- If a patient has hx of seizures- need to find out what meds he/she is taking; all seizure meds have therapeutic blood level
- Ativan (Lorazepam) or Valium (Diazepam) for status epilepticus. Must be given IV push !!!
STATUS EPILEPTICUS
NURSING INTERVENTIONS
- Maintain patient’s diet, Maintain seizure precautions; protect patient from injury during seizure, Assess post-ictal state: record time of sleep period, Maintain a patent airway, Monitor ABC’s
- First thing to do when patient seizes in front of you: check time & mentally record it/write it down!! To have duration of seizure activity → review in mind what happened preceding the seizure (resp pattern, pupils, weakness,.. Etc. && also check these post seizure)
- When you see signs of hypoxia/cyanosis: try to give blow by oxygen
MENINGITIS
DEFINITION: Inflammation of the brain and spinal cord meninges. Most commonly caused by a bacterial infection, but can be viral.
TYPES:
Septic: due to bacteria (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic: due to viral infection, lymphoma, leukemia, or brain abscess
Most commonly in adults: Bacterial infection: Neisseria meningitidis and Streptococcus pneumoniae
Neisseria meningitidis is transmitted by secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses.
Manifestations include SEVERE headache, fever, chills, systemic infection, petechial rash (seen with an infection; little red dots on hands/arms), changes in LOC, behavioral changes, nuchal rigidity (stiff neck→ chin to chest hard to do-one of the hallmark signs), positive Kernig’s sign, positive Brudzinski’s sign, and photophobia, tachycardia
Neuro Assessment findings: decreased level of consciousness; cranial nerve palsies: most commonly ptosis (eyes drooping), diplopia, facial weakness, tinnitus (ringing in ears), vertigo, and deafness; focal motor weakness, ataxia, seizures
MENINGITIS
DIAGNOSTIC FINDINGS
- Cultures: identify source of infection in blood, urine, nose, throat secretions, sputum
- CT scan or X-rays: assess for fractures, abscesses, or signs of infection in the chest, skull, and sinuses.
- Lumbar puncture (diagnostic gold standard): elevated CSF pressure; cloudy, turbid, or clear in appearance with WBC elevation, increased protein; decreased glucose → all positive for meningitis. Culture and sensitivity will identify bacteria unless cause is viral.
MENINGITIS
MEDICAL MANAGEMENT
- IV therapy; electrolyte replacement→ keep pt hydrated
- Oxygen therapy, Monitor VS, ECG, ICP, Neurovitals, Oxygen saturation, I/O, Activity: Bedrest, quiet, darkened room
- Ondansetron: when patients can’t hold down food/are nauseous this is given
- Early, High dose Antibiotics: Penicillin, Ampicillin, or Chloramphenicol, or one of the Cephalosporins; Vancomycin alone or in combination with Rifampin for resistant strains.
- Dexamethasone, (Decadron): given rather than prednisone because it is stronger and needed to decrease inflammation in the brain
- Treat dehydration, shock, and seizures → to determine shock watch for urine output and bp
- Antipyretics/ Analgesics: Tylenol, Advil
- Glucocorticoid: Decadron
- Osmotic Diuretic: Mannitol→ stronger than lasix, bumex; decreases cerebral edema
- Isolation precautions, Seizure precautions: pads around bed rails and patient to remain on bedrest.
- Anticonvulsants: Dilantin, Phenobarbital
MENINGITIS
NURSING MANGEMENT
- Maintain dimly lit, quiet environment (limit amount of visitors), asses for headache, semi-fowler’s position, Use cooling blanket or tepid bath to control temp, Provide nutrition as appropriate, Provide skin care, Report meningococcal meningitis to local health authorities, Assess for rehab and refer if appropriate, Provide home care instruction, Assess for infection spread to family members and friends or personal contacts.
Possible complications:
- Visual impairment, optic neuritis, deafness, personality changes, headache, seizures, paresis, and death
NEUROGENIC BLADDER
DEFINITION: An interruption of normal bladder innervation
Three types of neurogenic bladder may occur:
1. Spastic: upper motor neuron problem, Involuntary or frequent scanty urination without a feeling of bladder fullness, Possible spontaneous spasms of the arms and legs, Increased anal sphincter tone
2. Flaccid: lower motor neuron lesion, Overflow incontinence, Diminished anal sphincter tone, Greatly distended bladder with an accompanying feeling of bladder fullness (most at risk for UTI)
3. Mixed: cortical damage from some disorder or trauma, Dulled perception of bladder fullness, Diminished ability to empty the bladder, Urgency that can’t be controlled
- All are at risk for UTI, urolithiasis, renal failure
- Bladder program: patient goes to bathroom every hour/ 2 hrs/etc.; encourage patient to go on regular basis and drink fluids
Causes: Cerebral disorders (stroke, brain tumor, Parkinson’s disease, multiple sclerosis, dementia), Chronic alcoholism, Herpes zoster, Collagen diseases such as SLE, Disorders of peripheral innervation, Heavy metal toxicity, Spinal cord disease or trauma, Atherosclerosis, Acute infectious diseases such as transverse myelitis
NEUROGENIC BLADDER
NURSING INTERVENTIONS
Maintain patient’s diet and fluid intake, Assess renal status, Monitor VS and intake and output, Administer medications as prescribed, Indwelling catheter- strict aseptic technique, Assess for signs and symptoms of infection, Provide patient teaching if required for aseptic technique in self-catheterization, Patient teaching for intermittent self-catheterization, follow dietary measures to prevent renal calculi
NEUROGENIC BLADDER
MEDICAL MANAGEMENT
- Encourage fluids, monitor VS and I&O, asses renal status
- Tx: Valsalva’s maneuver, indwelling urinary catheter, intermittent self-catheterization
- Antispasmodics: if there are many bladder spasms; Pro-Banthine, Urispas, Dicyclomine
- Alpha-adrenergic blockers: Hytrin, Cardura
SPINAL TRAUMA
Spinal Cord Injury: traumatic injury to the spinal cord that results in sensory & motor deficits
Two types:
- Paraplegia: paralysis of the legs
- Quadriplegia: paralysis of all four extremities
Causes: car accidents, falls, gun shots, stab wounds, shallow water dive, infection, tumor, congenital
Patho: injury may result in complete transection of the spinal cord; associated edema & hemorrhage from the injury cause ischemia; necrosis & scar tissue form in area of the traumatized cord
Assessment findings:
- Paralysis below the level of the injury, Paresthesia below the level of the injury, Neck pain, Loss of bowel and bladder control, Respiratory distress, Numbness and tingling, Flaccid muscle, Absence of reflexes below the level of the injury, Loss of perspiration below the level of the injury
Diagnostic findings:
- Spinal x-rays: vertebral fracture
- CT and MRI scan: spinal cord edema, vertebral fracture, spinal cord compression
SPINAL TRAUMA
COMPLICATIONS
Respiratory System: Cervical injury or fracture above C4-total loss of resp muscle function. Mechanical ventilation required to keep patient alive
Cardiovascular system: Cord injury above T6 decreases SNS effects. Bradycardia occurs as a result of unopposed PNS on the heart and peripheral vasodilation causes hypotension.
Urinary system: Retention is common as is spinal shock. The bladder is atonic and becomes overdistended. Foley catheter is needed to drain bladder.
Integumentary system: Tremendous potential for skin breakdown. Pressure ulcers occur quickly and lead to major sepsis and infection.
GI system: Cord injury above T5 creates primary problems of hypomotility. Contributes to paralytic ileus and gastric distension. NG tube may be needed for relief of distension.
Peripheral problems: DVT is common problem especially in first 3 months. PE is leading cause of death.
AUTONOIC DYSREFLEXIA
Massive uncompensated cardiovascular reaction mediated by the SNS. Occurs in response to visceral stimulation in spinal cord lesions above T7.
- Life threatening situation- if not resolved can lead to status epilepticus, stroke, and death
- Most common precipitating cause is overdistended bladder or rectum.
- Manifestations include hypertension (up to 300 mmHg), blurred vision, throbbing headache, marked diaphoresis above level of lesion, bradycardia (30-40 bpm), piloerection, nasal congestion, and nausea.
Treatment is relief of cause- empty bladder or rectum!!–> suppository, foley catheter & then treat hypertension slowly
AUTONOMIC DYSREFLEXIA
MEDICAL MANAGEMENT
- Maintenance of vertebral alignment: Stryker turning frame, Crutchfield tongs, Halo brace, Cervical collar → keep alignment !
- Specialized bed: rotation (Rotorest, Tilt and Turn, Paragon)
- Position: flat, neck immobilized
- Endotracheal intubation and mechanical ventilation, NG tube with GI decompression
- IV therapy as needed; saline lock; replacement of electrolytes
- Diet: High protein
- Foley catheter
- Labs: CBC, Electrolytes, Glucose, ABG’s, urine osmolality, urine specific gravity
- Meds:
- Glucocorticoids: Decadron, Solumedrol,
- Anticonvulsants: Dilantin,
- Histamine antagonists: Tagamet, Zantac
- Antacids: Maalox, Mucosal barrier: Carafate
- Antianxiety agents: Valium
- Antihypertensive agents: Hyperstat, Apresoline
- Muscle Relaxants: Dantrium → for preventing muscle spasms
- Laxative: Bisacodyl
AUTONOMIC DYSREFLEXIA
NURSING MANAGEMENT
- Monitor the patient’s resp status, provide suctioning as needed. Monitor neuro status and neurovitals, Monitor vital signs, ECG, I/O, labs, arterial BP, O2, Keep patient flat, maintain body alignment, Turn patient using logrolling technique
- Administer fluids and electrolyte replacements, Administer meds as prescribed
- Initiate bowel and bladder retraining, Assess for spinal shock and autonomic dysreflexia
- S/S of autonomic dysreflexia: UTI and URI
- Provide skin care: Provide heel and elbow protectors and sheepskin; maintain skin integrity
- Apply antiembolism stockings, Provide Passive ROM exercises; use assistive devices, Encourage patient to express his feelings about changes in his body image, altered mobility, changes in sexual expression and function, Provide sexual counseling, Provide for rehabilitation; reinforce independence, Access resources to begin home care provisions and set-up for patient needs.
- Complications:
- Spinal shock, autonomic dysreflexia, resp. distress, osteomyelitis, pressure ulcers
- Possible surgical interventions: laminectomy, spinal fusion
ICP
INTRACRANIAL PRESSURE
Because the skull can’t expand, an increase in brain tissue, CSF, or blood, results in increased ICP
- Increased ICP results in decreased cerebral circulation and anoxia, which can lead to permanent brain damage.
- Early sign if increased ICP:
- confusion, changes in patients level of consciousness, changes in condition: restlessness, confusion, drowsiness, increased respiratory effort, & purposeless movements; pupillary changes and impaired ocular movements, weakness in one extremity or one side, headache that is constant, increasing in intensity, or aggravated by movement or straining
- Late sign of increased ICP:
- Respiratory and vasomotor changes; Projectile vomiting
- VS: increase in systolic blood pressure, widening of pulse pressure, and slowing of the heart rate; pulse may fluctuate rapidly from tachycardia to bradycardia and temperature increase
- Cushing’s triad: bradycardia, hypertension, and bradypnea
- Further deterioration of LOC; stupor to coma
- Hemiplegia, decortication, decerebration, or flaccidity
- Respiratory pattern alterations including Cheyne-Stokes breathing & arrest
- Loss of brain stem reflexes: pupil, gag, corneal, and swallowing
CALCULATE CPP
CEREBRAL PERFUSION PRESSURE
- CCP (cerebral perfusion pressure) is closely linked to ICP
- CCP = MAP (mean arterial pressure) – ICP
- Normal CCP is 70 to 100
- A CCP of less than 50 results in permanent neurologic damage
GLAUCOMA OPEN ANGLE
Glaucoma is increased intraocular pressure with peripheral vision loss
Open Angle Glaucoma
- Develops slow with NO symptoms of pain or pressure
- Nothing noticed until suddenly vision is compromised
- Tx: B-adrenergic receptor blocker (Timoptic), alpha-adrenergic agent (Epifrin), cholinergic agent (miotics), carbonic anhydrase inhibitors (hyperosmotic agents)
CLOSE ANGLE GLAUCOMA
ACUTE
- Sudden excruciating pain, n/v
- colored halos around lights
- frosted cornea
- OCULAR EMERGENCY; immediate care topical cholinergic, hyperosmotic agents with LASER peripheral iridotomy
SUB-ACUTE / CHRONIC
- Appear gradually
- Colored halos
- Eye or brow pain
- Tx for chronic same as open angle
Treatment for the patient with hearing loss and Meniere’s disease
Meniere’s Disease - Increased endolymph causes rupture, mixes high-K endolymph with low-K periplymph, leads to damaged cochlear hair cells
- Vertigo with n/v, tinnitus, ear fullness, hearing loss, sudden drop attack
Tx: treating symptoms not disease
- stabilize self during attack, antihistamines, anticholinergics, benzodiazepines (valium/diazepam), antiemetic (Zofran), antivert
Geriatric patients: end of life care
Palliative care vs. Hospice
Palliative care:
- comfort, can still receive treatments
- possible to graduate from palliative care
- ex: after ARF if kidneys start functioning again
Hospice:
- end of life comfort;
- 6 months or less left to live,
- tx: analgesics
Why is HIV becoming more prevalent in the geriatric community
Because older patients think that because they are old, they are not likely to get pregnant or get someone pregnant, so they do not use protection.
Responsibility of the nurse in
pre-op care of the patient
- Pre-op will be centered on the checklist, consent, and patient understanding of the surgery they are to have.
- Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed
- Checklist: know that one exists (page 423) Has the procedure been explained to the pt? Have they consented to receive blood? Are they an organ donor? DO the have DNR? Is there an H&P? Are they NPO, are they on heparin?
- Consent: Freely given without coercion, must be 18, staff must witness signature
- Understanding of surgery: Discuss advance directives, patient education on benefits of controlling pain, time with patient/family and give therapeutic touch.
Responsibility of the nurse
intra-operatively
- Begins when the patient is transferred onto the OR bed and ends with admission to the PACU (post anesthesia care unit)
- The intra-op will focus on the “time-out” to ensure the right part of the patient is being operated on
“Time out” is when you stop and make sure you’re
- Operating on the right person
- Right place and
- Right area of body
- Everyone knows their roles
Responsibility of the nurse in the
post-operative period
Post-op will be focused on the safe awakening of the patient from anesthesia and what to do if the patient is not breathing well or if they are bleeding from their incision, or if their vital signs are not stable.
- Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home
- Safe Awakening: Maintain ventilation and prevent hypoxemia and hypercapnia. (page 457)
- Patient not breathing: (page 457) Hypopharyngeal obstruction. Tilt head back with neck supportive and open the jaws to open airway. Use a tongue suppressor. Use a endotracheal tube, when can they be extubated?
Patient bleeding from incision: (page 459) If bleeding is evident.
- Sterile gauze pad and a pressure dressing are applied.
- Site of the bleeding is elevated to heart level if possible.
- Patient is placed in the shock position.
- If hemorrhage is suspected but cannot be visualized, the patient is taken back to the OR for emergency exploration
- Vital signs not stable: shock might ensue, give IV fluids, specifically lactated Ringer solution, 0.9% sodium chloride. Give O2
How do geriatric patients differ from adult patients in terms of medication administration?
- Need to reduce doses
- Treat the patient, not the numbers (Well focus on that, but not primarily)
Why is compliance with medications difficult for geriatric patients?
- We over prescribe them
- Be aware of cost, as many cannot afford, so they don’t fill or take them.
- Will resort to pill rationing (cutting pills in half)
What are advanced directives and the power of attorney for patients?
Advance health care directives
- instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.
- A living will is one form of advance directive, leaving instructions for treatment.
- Another form of authorization is the power of attorney for health care. People may have one or the other or a combination of both.
Power of Attorney
- A durable power of attorney allows a competent person - (the “principal”) to appoint an agent to make decisions for the principal when the principal is incapacitated and unable to make decisions.
What substances are most commonly abused today?
- Alcohol and opioids
Know the second part of the Neuro lecture, neuromuscular disorders- ALS
Multiple Sclerosis (MS)
- SS: INTENTION tremors
Parkinson’s triad
- S/S: RESTING tremors, shuffling gait, bradykinesia (slow movements)
- Tx: L-dopa
