FINALS Review Flashcards
pts with upper motor neuron injuries will develop this type of bladder and voiding for male (2) and female (1)
spastic bladder male-micturation reflex and condom cath female- in/out cath
lower motor neuron injury will result in this type of bladder; voiding for men/women (2)
flaccid bladder male and female - crede and in/out catheter
interventions neurogenic bladder (2)
1stool softener or bulk forming laxative daily 2dulcolax suppository or digital stim only as ordered.
how to assess an ileus (1)
listening bowel sounds
type of plegia with t1 injury
paraplegia
type of plegia with c level injury
quadraplegia
major concern with c4 level injury, interventions (6)
respiratory: ventilator, sp 02, oxygen, cough and deep breathing exercises, suction, cough assist
interventions neurogenic shock main problem(1) - plus 3 smaller resulting problems
tissue perfusion dt hypotension, edema and loss of temp regulation postural hypotension -attention with safe transfer safety thrombophlebitis- anticoagulant
muscle tone in injury above L1-L2?
spastic
muscle tone in injury below L1-L2
flaccid
interventions for muscle strength and tone (2)
active and passive ROM
areflexic bowel
flaccid bowel
reflexic bowel
spastic bowel
result of damage to the clonus medularis and cauda (3) equina -lower ext -bladder -bowel
flaccid lower extremities, areflexic bowel and bladder
nuerogenic shock is usually with injuries at this level
t6 and above
signs of spinal shock- (3)
loss of reflexes loss of sensation flaccid paralysis below level of injury
signs of neurogeic shock (6)
hypotension, bradycardia, decreased cardiac output, peripheral vasodiation, venous pooling, loss of ns stimulation
decreased stimulation of the systemic ns would result in (3) which is characterisctic of neurogenic shock
perifpheral vasodilation venous pooling decreased cardiac output
ipsilateral loss of motor function, position and vibratory sense, vasomotor paralysis
brown sequard
contralateral loss of pain and temperature
brown sequard
motor paralysis and loss of pain and temperature
anterior cord syndrome
pain and temperature and motor functions intact
posterior cord syndrom
loss of propioception
posterior cord syndrome
sensation, touch position vibration and motion intact
anterior cord syndrome
motor weakness and sensory loss in upper and lower extremeties
central cord syndrome
upper extremities are more affected in this cord syndrome than lower
central
movement of these are intact with c8 injury
arms
risk for these conditions after craniotomy
DI and siadh
give this med for DI to retain urine, same action as __
DDAVP or desmopressin same action as ADH
phenytoin side effects and interventions
gingival hyperplasia- oral care skin rash- notify md dysrhythmias/ hypotension- decrease infusion rate CNs effects- notify MD teratogenic cleft palate, heart defects-avoid during pregnancy
CNS effects of phenytoin (4)
ataxia, nystagmus, double vision, cognitive impairment
substances increase effects of phenytoin (5)
alcohol, diazepam, cimetidine, valproic acid, cns depressants
substances decreases effects of phenytoin (3)
alcohol, carbamazepine, phenobarbital
phytoin decreases effects of ex: (3)
hepatic drug-metabolizing enzymes; glucocorticoids, warfarin, oral contraceptives
pt teaching re phenytoin (4)
do not stop abruptly no driving take with meals oral hygiene dt gingival hyperplasia
prioritization of patient in disaster triage
based on ABCDEFGHI Airway Breathing Circulation Disability Environment F
hypoventilation leading to respiratory distress in spinal cord injury is due to (2) can result in (2) interventions (4)
due to decreased vital capacity and intercostal and diaphragmatic muscle dysfunction – results in secretion pooling and ineffective cough – suction and mechanical ventilator,02, assist coughing
areas to assess for respiratory function in sc injury (10), pt who is unable to do this without taking a breath needs immediate attention
breath sounds ABGs PaCO2 60 respiratory effort/ pattern subjective comments amount and color of sputum tidal volume vital capacity skin color cannot count to 10 without taking a breath needs immediate attention
contraindications for jeart transplant
->70 yo -severe pulmonary disease with likely vent dependent status post transplant -malignancy or life threatening condition with
indications for heart transplant
-end stage heart disease -inoperable valve disease -recurrent life threatening dysrhythmias unresponsive to interventions - function limiting cadiac abnormalities with mortality risk of >50% at 2 year
transplant donation are matched based on (5)
hla typing or match, abo compatibility, geographical location, time on the wait list, and medical urgency
positive crossmatch vs negative crossmatch and what type of transplant is crossmatch done
crossmatch is absolutely done for kidney transplants. a negative crossmatch mean no antibodies to the donar organ and it is safe to proceed with the transplant
hyperactute rejection time frame
minutes to hours, rarely occurs because of hla typing just before transplant, the blood vessels are rapidly destroyed, removal of organ
acute rejection time frame and fix, activated by these (2)
within 6 months, lymphocyte and antibodies react to the donated organ. fixed by immunosuppressive thereapy, corticosteriods, polyclonal and monoclonal antibodies. person is at risk for infection especially early in the transplant
chronic rejection timeframe, caused by these antibodies. main and specific manifestations kidney, heart, lungs liver
months and years and no fix mainly supportive. caused by b and t cells. manifestations of fibrosis and scarring kidney- glomerulopathy/fibrosis heart- advance CAD lungs- loss of bile ducts liver- bronchiolitis obliterans
risk when taking immunosuuppressants (2)
toxicity and increased risk for infection
examples of immunosuppressants (7)
cyclosporin, tacrolimus, corticosteroids,mycophenolate mefetil, sirolimus, azathioprine, cyclophosphamide
examples of monoclonal antibodies (3)
natalizumab, daclizumab, basiliximab, muromonal-Cd3
se of cyclosporin (10)
neurotoxic, nephrototix, hepatotoxic, gingival hyperplasia, lymphoma, hypertension, hirsutism, leukopenia, seisures, tremors
loss of consciousness in this type of seisure
tonic clonic
definition of tonic
stiffening of the body
definition of clonic
jerking of the body
tonic clonic seisure has these three elements during a seisure and can have these (4)
loss of consciousness, tonic(stiffeining), clonic (jerking), can have excess drooling, cyanosis, incontinence, tongue or cheek biting
s/sx of tonic clonic seisures postictal (3)
muscle soreness, tiredness, sleepy
hyyperventilation and flashing lights may happen before this type of seisures, which manifest as __,usually seen in children only; seen on the eeg as this -___
absence seisure, staring or daydreamig that lasts for a few seconds. . see 3hz spike an wave pattern
loss of consiousness and loss of muscle tone
clonic seisure
sudden loss of muscle tone and drop to the ground, greatest risk for head injury, consciousness returns by the time person hits the ground
atonic siesure
increased tone of extensor muscles, risk for falls in this type of seisure
tonic seisure
types of generalized seisures (6)
tonic clonic absence atypical absence atonic tonic myoclonic
sudden and excessive jerking of the body
myoclonic
2 types of focal seisures and consciousness
simple focal- no loss of consciousness complex focal- loss of consciosness
simple focal seizure s/sx
aura (unusual feelings or sensations) before a seizure may feel sad, anger, joy, nausea, may see hear, smell, taste or feel things that aren’t there
complex focal s/sx, duration
loss of consciousness then automatism or repetitive movements such as lip smacking, picking at clothing, fumbling with objects, walking away, lasts for a few seconds.
patient teaching re seizures about lifestyle (5)
get enough sleep, avoid alcohol and avoid fatige, proper diet, exercise
the most dangerous type of seisure that could result in hypoventilation, hypoxemia, dysrhythmias, hyperthermia and systemic acidosis
tonic clonc status epilepticus
topiramate and levetiracetam treat all types of seizures except this type
absence seisures
important to monitor for leviteracetam
suicide
cns effs of leviteracetam (6)
weakness, dizziness, agitation, anxiety, depression, suicide
cns side effs of topiramate (6)
cns effs (somnolence, dizziness,ataxia, nervousness, diplopia, confusion, impaired cognitive fx)
interventions for metab acido in topiramate monitor_ report (3) dose
monitor bicarb report hyperventilation, fatigue, anorexia dc or reduce dose
meds decrease topiramate levels
phenytoin and carbamazepine
topiramate increases level of __
phenytoin
interventions re se of angle closure glaucoma in topiramate
1vision check to measure ocular pressure 2pt will experience pain, redness, blurring of vision
