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Med Surg > Med-Surg Exam 2 > Flashcards

Med-Surg Exam 2 Flashcards

1
Q

primary brain tumors rarely…

A

spread to other parts of body

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2
Q

most common glioma

A

*glioblastoma multiforme (GBM) …malignant

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3
Q

most common brain cancer

A
  • meningiomas

- Grade 1 most common which is cured by surgery (slow growing and benign)

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4
Q

Acoustic neuroma

A

*benign tumor of 8th cranial nerve

(1) hearing (loss of/tinnitus)
(2) Balance (vertigo)

-can grow and press on 5th cranial nerve & cause facial numbness/tingling

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5
Q

pituitary symptoms

A

**HEADACHES

functioning ones are those that produce hormones most commonly from anterior pituitary (growth hormone, prolactin, ACTH, TSH)

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6
Q

brain angiomas

A

-masses composed largely of abnormal blood vessels found in brain or on surface (most often in CEREBELLUM)

^^^^^risk for hemorrhagic stroke (narrow BV)

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7
Q

cerebral metastes

A
  • 50% accounted for by lung, breast, and GI tract

- produces localized (focal) or generalized neuro symptoms

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8
Q

risk factors brain cancer

A
  • male
  • cause for majority is elusive**
  • smoking
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9
Q

vasogenic edema

A

-caused by disruption of blood brain barrier from increase in mass

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10
Q

ICP

A

Cushing’s triad (late signs)
1-increased BP
2-decreased pulse (brady)
3-decreased respirations

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11
Q

n/v with brain cancer

A

-unrelated to food intake (vagal nerve stimulation)

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12
Q

visual disturbances w/ brain cancer

A

-papilledema

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13
Q

gold standard for detecting brain tumors

A

MRI

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14
Q

PET

A

activity rather than structure

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15
Q

temporal lobe fxns

A

-language, behavior, memory, emotions

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16
Q

parietal lobe

A

L from R

  • sensations
  • reading/writing
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17
Q

Temodat

A

*temozolomide

**given orally and can pass the blood brain barrier

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18
Q

corticosteroids in brain cancer

A

-reduce cerebral edema

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19
Q

SCC

A

-spinal cord compression

**emergency occurring because of tumor extension into epidural space

ASSESSMENT: pain, loss of reflexes above tumor level, loss of sensation, weakness/paralysis

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20
Q

how do we tx SCC

A

-relieve cord compression w/ use of IV steroids (dexamethasone) to decrease edema and inflammation/swelling

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21
Q

sudden onset of neurologic deficit

A

**poss vertebral collapse associated w/ spinal cord infarction

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22
Q

epilepsy dx

A
  1. 2 or more unprovoked seizures more than 24 hrs apart
  2. 1 seizure and probability of future seizures
  3. dx epilepsy syndrome
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23
Q

status epilepticus

A

-seizure occurring 5-10 minutes more or longer less likely to stop w/out intervention

**don’t get enough O2=airway problem

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24
Q

some causes of seizures

A
  • hyponatremia/hypoglycemia/dehydration
  • illness (with and without increased fever)
  • sleep deprivation
  • stress
  • menstrual cycle
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25
Q

motor seizures

A

tonic-clonic, and epileptic spasms

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26
Q

non-motor seizures

A

-seizures w/ behavior arrest

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27
Q

tonic-clonic seizures

A

-both sides of brain and begin with rigidity (tonic) and followed by clonic activity of all extremities (stiffening/jerking of body)

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28
Q

atonic seizures

A

-sudden loss of muscle tone resulting in falls or drops to ground

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29
Q

myoclonic seizures

A

-jerking movements of muscle group WITHOUT loss of consciousness

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30
Q

seizure caused by hypoglycemia

A

-rapid infusion of dextrose

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31
Q

Phenytoin

A

(Dilantin)

*administer in IV slowly because of effects on myocardium & potential for arrhythmia development/phlebitis

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32
Q

neuroleptanalgesic agents

A

-combo of opioids and sedative drugs/tranquilizer

**fentanyl (analgesic) and droperidol (tranquilizer/sedative)

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33
Q

leading cause of seizures in the elderly

A
  • cerebrovascular disease (leading cause)

* other risk factors: head trauma, dementia, infection, alcoholism, aging

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34
Q

Bacterial Meningitis 95% have 2 of 4

A
  1. headache
  2. fever
  3. nuchial rigidity
  4. altered LOC
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35
Q

clinical manifestations meningitis

A
  • altered LOC
  • headache/fever (initial symptoms)
    • Kernig (hip/knee flexed at 90 and then straightened, resistance to this/can’t flex)
    • Brudzinski (patient head flexed and knees come up)
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36
Q

nursing management of meningitis

A
  • FLUIDS and assess for dehydration/shock

- control of seizures (common in meningitis)

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37
Q

bacterial meningitis

A

-droplet isolation for at least 1st 24 hrs for bacterial meningitis

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38
Q

SIADH

A

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH) [1]. If water intake exceeds the reduced urine output, the ensuing water retention leads to the development of hyponatremia

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39
Q

most common cause of viral meningitis

A

-enteroviruses

poliovirus, coxsackievirus, echovirus

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40
Q

difference in viral vs bacterial meningitis

A

-viral meningitis NOT associated w/ altered mental status and seizure activity

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41
Q

tx for HSV / encephalitis

A

Acyclovir (Zorivax)

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42
Q

encephalitis symptoms

A
  • initial: stiff neck/headache/fever/confusion

* focal neurologic symptoms

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43
Q

gold standard HSV encephalitis dx

A

PCR test

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44
Q

Arboviral encephalitis

A

**west nile virus most common, commonly affects ELDERLY

  • no meds available, management aimed at controlling seizures and increased ICP
  • begins as flu like symptoms then symptoms reflect area of brain involved
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45
Q

meningeal exudate in arboviral enceph.

A

**compounds clinical presentation, irritating the meninges and increasing ICP

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46
Q

west nile encephalitis specific signs/symptoms

A
  • maculopapular or morbilliform rash
  • flaccid paralysis
  • parkinsonian movements
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47
Q

Bell’s palsy

A

unilateral inflammation of 7TH cranial nerve (weakness or paralysis of facial muscles of the ipsilateral (same side) of the affected facial nerve)

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48
Q

Bell’s palsy other signs

A
  • increased lacrimation (tearing)

- painful sensations in face/behind ear/in eye of affected side

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49
Q

meds Bell’s palsy

A

corticosteroid (reduce inflammation and ^ blood flow) and acyclovir

*heat to promote blood flow

**protect from eye injury

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50
Q

MS

A

most pts have RR (relapsing remitting course)

  • vision loss (unilateral) preceded w/ orbital pain that ^ with eye movement)
  • diplopia (double vision)
  • nystagmus
  • ataxia (impaired coordination of movements)
  • bladder dysfunction
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51
Q

myasthenia gravis

A

**reduction in acetylcholine receptor sites causing muscular weakness (worsens with movement and gets better with rest)

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52
Q

MG tx

A
  • *weakness of VOLUNTARY muscles
  • administration of anticholinesterase meds and immunosuppressants AND ASPIRATION RISK
  • myasthenic crisis=exacerbation of MG symptoms
  • cholinergic crisis=overmedication
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53
Q

Gullain-Barré Syndrome

A

-attacks myelin of peripheral nerves and some cranial nerves (UPWARD progression of motor weakness) and general weakness in lower extremities

  • sudden motor/sensory losses most often from viral infection
  • unstable cardiovasc system (brady/tachy, HTN/hypo)
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54
Q

autoimmune:

A

MG, MS, Gullain-Barre

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55
Q

GBS does not…

A

affect cognitive function or LOC

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56
Q

what to watch for with GBS

A

-impending neuromuscular respiratory failure

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57
Q

CSF and GBS

A

-elevated protein levels

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58
Q

Parkinson dz

A

TRAP (cardinal signs)

T-Tremor
R- Rigidity of muscles
A- Akinesia/Bradykinesia (without or decreased body movement)
P- Postural disturbances (gait/balance dx)

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59
Q

ALS

A
  • Amyotrophic Lateral Sclerosis

* loss of both upper and lower motor neurons

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60
Q

cervical disc herniation

A

usually occurs at C5-C6 and C6-C7 interspaces

  • pain/stiffness in neck, top of shoulders, region of scapulae
  • paresthesia and numbness of upper extremities
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61
Q

cervical disc herniation tx

A
  • hot/moist compresses

- analgesic/NSAID/sedative/muscle relaxants

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62
Q

NSAIDS and cerv disc hern.

A

discontinue with bone fusion sx (can impede healing)

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63
Q

lumbar disc herniation

A
  • L4-L5 and L5-S1 (most common)

* low back pain with muscle spasms, followed by radiation of pain into one hip and down into leg (sciatica)

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64
Q

lumbar disc hern. test

A

-straight leg-raising test

stretches sciatic nerve and causes pain down leg

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65
Q

presbycusis

A

age related hearing loss

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66
Q

hearing loss can be…

A

(1) result of conduction prob (external ear dx)
(2) sensorineural (damage to cochlea or vestibulocochlear nerve
(3) mixed
(4) psychogenic

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67
Q

some risk factors for hearing loss

A
  • bacterial meningitis

- tympanic membrane perf

68
Q

otalgia

A

sensations of fullness or pain with or without hearing loss

69
Q

meds motion sickness

A
  • antihistamines (block conduction of vestibular pathway of inner ear)
  • anticholinergics (antagonize histamine response)
  • may cause drowsiness/dry mouth
70
Q

Ménière Disease

A
  • INNER ear

* causes vertigo, tinnitus, feeling of pressure in ear, fluctuating hearing loss

71
Q

risk factors tinnitus

A
  • ototoxic substances
  • thyroid dz
  • vit B deficiency
  • hyperlipidemia
  • fibromyalgia
72
Q

BPPV

A

(benign paroxysmal positional vertigo)

  • often caused by head trauma/infections
  • sneeze/cough can trigger
73
Q

ototoxic meds

A

*aminoglycoside ABx most common (gentamicin)

74
Q

acoustic neuroma dx

A

MRI

75
Q

trigeminal nerve involvement in acoustic neuroma=

A
  • facial paralysis
  • discomfort to touch
  • loss of taste
76
Q

emmetropia

A

normal vision

77
Q

refractive errors

A

-shortened or elongated eyeball

78
Q

myopia

A

nearsightedness (distant vision is blurred)

79
Q

hyperopia

A

farsightedness (near vision blurred)

80
Q

astigmatism

A

irregularity in the curve of the cornea

81
Q

blindness

A

BCVA (best corrected visual acuity) ranging from 20/400 to no light perecption

82
Q

Contrast-Sensitivity training

A

-turn on lights, if pt sees better with lights on then they may benefit from magnification

83
Q

Glare testing

A
  • realistic evaluation of pt’s ability to see in their environment
  • objects calibrated to create glare and test vision
84
Q

normal pressure in eye

A

at or below 21 mm Hg

85
Q

risk factors glaucoma

A
  • AA
  • older than 60
  • DM
  • cardiovasc dz
  • migraines
  • myopia
  • eye trauma
  • prolonged use corticosteroids
86
Q

symptoms glaucoma

A
  • HA
  • seeing halos around lights
  • pupil vertically oval, fixedm and nonreactive to light/accommodation
87
Q

goal of glaucoma tx

A

-reduce current pressure by 30% and is lowered until stable and no signs of optic nerve damage

88
Q

medication for glaucoma

A

-beta-blockers (decrease production of aqueous humor and decrease IOP)

89
Q

cataracts

A
  • painless BLURRY vision (surroundings are dimmer), light scattering, sensitivity to glare
  • diplopia
  • color shifts seeing more yellowish-brown tint
90
Q

cataracts risk factors

A
  • myopia/retinal detachment/infection
  • corticosteroids
  • chem burns
  • smoking
  • poor nutrition
  • obesity
  • dehydration
  • DM
91
Q

hyphema

A

bleeding into anterior chamber of eye

92
Q

scleral buckle

A

retinal detachment (silicone or sponge sewn onto sclera at site of tear, holds in place until scarring seals tear

93
Q

AMD

A

age related macular degeneration (development of drusen or tiny yellowish spots)

~loss of central vision but preserve peripheral vision (words seem broken or straight lines seem crooked)

  • two types:
  • dry (90%)
  • wet
94
Q

orbital trauma

A

-priority is preservation of vision

Assess for: displacement of eyeball, edema, hemorrhage

*cold compress in early phase then warm compress

95
Q

leading cause of blindness among children and young adults

A

*ocular trauma

96
Q

orbital cellulitis

A

-monitor IOP (edema, swelling)

**can result in permanent vision loss

97
Q

enucleation

A

-removal of entire eye and part of optic nerve

98
Q

evisceration

A

surgical removal of intraocular contents

99
Q

exenteration

A

removal of eyelids, eye, and various amounts of orbital contents

100
Q

HTN risk factor for

A
  • CAD
  • atherosclerotic cardiovasc dz
  • heart failure
  • stroke
  • renal failure
101
Q

HTN dz

A

2 or more readings taken during two or more contacts with healthcare provider

OR

-one reading SBP 210 mmHg or DBP 120 mmHg

102
Q

secondary HTN

A

-fix underlying pathology

5-10%

*renal dz, hyperaldosteronism, pheochromocytoma

103
Q

HTN crisis

A
  • lower BP w/ IV Nipride, TG, Labetalol, Hydralazine (pregnant pts)
  • but SLOWLY LOWER to prevent organ hypoperfusion
104
Q

risk factors HTN

A
  • diet: high Na+
  • obesity: high fat
  • obstructive sleep apnea
  • excess alcohol
  • physical inactivity
  • dyslipidemia (high cholesterol)
105
Q

HTN cardiac manifestations

A
  • angina
  • MI
  • left ventricular hypertrophy (work and push against pressure to push blood out and starts remodeling & new cells aren’t as efficient)
  • heart failure
106
Q

HTN kidney manifestations

A
  • increased BUN and creatinine

- micro albuminuria (early sign of vascular damage)

107
Q

HTN cerebrovascular manifestations

A
  • TIA

- stroke

108
Q

retinal changes HTN

A
  • hemorrhages
  • exudates
  • arteriolar narrowing
  • cotton wool spots
  • papilledema

(signs of HTN in BVs of retina)

109
Q

secondary HTN –endocrine dx’s

A
  • Cushing’s dz
  • Hyperthyroidism
  • Hyperaldosteronism (Mineralocorticoid HTN)
  • Pheochromocytoma (tumor in adrenal glands that release catetcholamines which spike HR and BP but by time you get to ER its gone)
110
Q

secondary HTN–renal dz

A
  • Renal Parenchymal Dz

- Narrowing of Renal Arteries

111
Q

other causes secondary HTN

A
  • vascular dx (Coarctation of aorta)
  • neuro dx (Increased ICP)
  • stress
  • pregnancy
  • sleep apnea
  • drugs (coke, meth, oral contraceptives)
112
Q

high Bp and brain

A

risk of stroke, often hemorrhagic

113
Q

HTN complications

A
  • renal insufficiency/failure
  • encephalopathy
  • headache
114
Q

12 Lead ECG

A

-can show left ventricular hypertrophy (^ in QRS amplitude)

115
Q

w/ diuretics monitor:

A
  • Na+, K+, Mg+
  • daily weight
  • side effects: dry mouth, thirst, n, weak, drowsy, postural hypoTN
116
Q

ACE inhibitors and ARBS

A
  • monitor for persistent cough
  • monitor for hyperkalemia
  • monitor for angioedema
117
Q

Beta Blockers

A
  • monitor pts w. chronic respiratory dz
  • monitor HR for brady and hypoTN
  • avoid sudden discontinuation
118
Q

Calcium Channel Blockers

A

*diltiazem

  • monitor for reflex tachy
  • administer on empty stomach
  • avoid sudden discontinuation
119
Q

vasodilators

A
  • monitor for peripheral edema

- monitor for s/s heart failure

120
Q

causes hypertension crisis

A
  • HTN poorly controlled (biggest cause)
  • HTN undiagnosed
  • pts discontinuing meds abruptly
121
Q

HTN emergency

A

-assessment reveals actual or developing clinical dysfunction of target organ

122
Q

gradual reduction in BP

A
  • 10% in 1st hr
  • another 15% during next 3-12 hrs to BP no less than 160/110
  • gradual reductions made over the next 24-48 hrs
123
Q

HTN urgency associations

A
  • severe headaches
  • nosebleeds
  • anxiety

**oral agents to normalize within 24-48 hrs

124
Q

vital signs with HTN emergency/urgency

A
  • vital signs every 5 min for rapid changing VP

- vital signs every 15-30 if BP more stable

125
Q

HTN and hemodynamics

A
  • risk for decreased cardiac output

- risk for decreased tissue perfusion

126
Q

most common cause CVD

A

-atherosclerosis

127
Q

Metabolic syndrome (6 conditions that can lead to heart dz)

A
  • has to be 3 or more:
    (1) insulin resistance
    (2) abdominal obesity
    (3) dyslipidemia (low HDL, high LDL)
    (4) hypertension
    (5) proinflammatory state
    (6) prothrombotic state (increased chance of clots)
128
Q

diaphoretic

A

**can be sign of myocardial ischemia as well as n/v

129
Q

angina is…

A

TRANSIENT/REVERSIBLE episode of inadequate coronary perfusion causing myocardial ischemia

130
Q

Printzmetal’s Angina

A

(Variant or Vasospastic) caused by coronary artery spasms….UNRELATED to activity and often at nigh

***transient/reversible–ST segment changes

131
Q

Silent Myocardial Ischemia

A
  • may have ECG changes on stress test

- asymptomatic

132
Q

Refractory Angina

A

-severe angina that persists with use of two or more anti-anginal meds (nitrates)

133
Q

rule out an MI

A

-cardiac enzymes:

  • troponin I (gold standard)
  • CK-MB
  • myoglobin
134
Q

gold standard for CP

A

-coronary angiography or cardiac cath

135
Q

antiplatelets for angina

A

aspirin/clopidogrel (plavix)

136
Q

IIB/IIIa inhibitors

A
  • prevent platelet aggregation

* IV: Integrilin, Aggrastat

137
Q

causes of myocardial infarction (MI)

A
  • ruptured plaque
  • blood clot
  • severe anemia (anemic=decreased hemoglobin)
  • severe vasospasm (lasts long enough to cause MI)
  • cocaine induced MI
138
Q

w/in 20 minutes MI

A

-initial damage starts in subendocardial layer (non Q wave infarct)

139
Q

w/in 1-6 hrs MI

A

-progresses to epicardial layer

140
Q

transmural MI

A

-involves death of entire thickness of myocardial wall (Q wave infarct–absence of depolarization)

141
Q

P wave, QRS wave, T wave

A

P-depolarization of atria (round and precedes QRS)

QRS-represents depolarization of ventricles

T wave-represents repolarization of ventricles

142
Q

myocardial ischemia, myocardial injury, and myocardial necrosis

A
  • ischemia= inverted T wave, decreased BF but still reversible/muscle viable
  • injury= ST elevation, still reversible/viable muscle
  • necrosis= Q wave (0.4 sec by 1mm deep or greater than 1 square)
143
Q

Q wave

A

electrically silent area and can be sign of previous MI

-in leads V2-V3

144
Q

decreased cardiac output symptomes

A
  • Cerebral: decreased LOC, restless
  • Cardiac: tachy, hypotension
  • Respiratory: decreased O2 sat, dyspnea
  • Kidney: decreased UOP
  • Skin: cool, diaphoretic
  • Pulses: weak
145
Q

MONA tx MI

A
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
146
Q

Analgesics not just for pain in MI

A

*Morphine Sulfate 2-4 mg IV (NOT demerol)

(1) analgesic
(2) reduce preload/afterload (vasodilator and decreases BP)
(3) calming
(4) decrease air hunger/bronchodilator
(5) reduce myocardial O2 consumption

147
Q

first line of tx if cardiac cath not available for MI

A

-fibrinolytic therapy

148
Q

pump failure

A
  • heart failure=20% of L ventricle damaged

* Cardiogenic shock= 40% left V damaged

149
Q

systolic vs diastolic heart failure

A
  • systolic: weakened heart muscle

- diastolic: stiff and noncompliant heart muscle

150
Q

BNP

A

increase=heart failure (overstretching of L vent muscle)

151
Q

Left Heart Failure (HFrEF)

A

“systolic heart failure–EF less than 40%” –> can’t pump enough blood out of L ventricle

*pulmonary congestion

152
Q

Left Heart Failure (HFpEF)

A

“diastolic heart failure–EF greater than 50%”

*from: resistance to filling of one or both ventricles because stiff/noncompliant leading to pulmonary congestion

153
Q

nitrates

A

reduce afterload by producing arterial and venous vasodilation

154
Q

cardiac tamponade signs

A

Beck’s Triad
1-hypotension
2-jugular vein distension
3-muffled heart sounds (ABSENT breath sounds with pneumothorax)

155
Q

Vtach

A

more than 3 PVCs in a row

156
Q

vtach no pulse SCREAM

A 
Shock 
CPR 
Rhythm check 
*IV MEDS* 
Epi 
Antiarrythmitics meds (amiodarone)
157
Q

PEA 6 H’s

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion acidosis (assess ABG)
  • Hyper/hypokalemia
  • Hypoglycemia
  • Hypothermia
158
Q

PEA 6 T’s

A
  • Toxins
  • Tamponade cardiac
  • Tension pneumothorax
  • Thrombosis Heart
  • Thrombosis lung
  • Trauma
159
Q

Acute arterial occlusion 6 P’s

A 
Pain 
Pulselessness 
Pallor/cyanosis 
Paralysis
Polar sensation (cold)
160
Q

thoracic aorta management

A
  • control BP (beta blocker metoprolol)

- IV emergent nitroprusside (Nipride)

161
Q

AAA greater than…

A

…4.5 cm needs surgery

162
Q

Virchow’s Triad

A

DVT formation

  • stasis of blood
  • endothelial damage/inflammation
  • hypercoagulability (dehydration, smoking, anemia)
163
Q

Coumadin

A

PO

-regulated before d/c and interferes with liver synthesis of vit K and some clotting factors

164
Q

arterial ulcers vs venous ulcers

A
  • arterial: cold/hairless, VERY painful pale and gray base on heels, toes, and dorsum
  • venous: warm, thickened pigmented area and moderate pain pink base on medial aspect of ankle
165
Q

gangrene

A

does NOT occur w/ venous ulcers

166
Q

primary vs secondary varicose veins

A

primary–dilated tortuous superficial veins (valves not fxning)

secondary–early episode of DEEP VEIN thrombosis or incompetent deep veins where blood is shunted to superficial veins

Med Surg (4 decks)

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