Med-Surg Exam 2 Flashcards
1
Q
primary brain tumors rarely…
A
spread to other parts of body
2
Q
most common glioma
A
*glioblastoma multiforme (GBM) …malignant
3
Q
most common brain cancer
A
- meningiomas
- Grade 1 most common which is cured by surgery (slow growing and benign)
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
5
Q
pituitary symptoms
A
**HEADACHES
functioning ones are those that produce hormones most commonly from anterior pituitary (growth hormone, prolactin, ACTH, TSH)
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)
7
Q
cerebral metastes
A
- 50% accounted for by lung, breast, and GI tract
- produces localized (focal) or generalized neuro symptoms
8
Q
risk factors brain cancer
A
- male
- cause for majority is elusive**
- smoking
9
Q
vasogenic edema
A
-caused by disruption of blood brain barrier from increase in mass
10
Q
ICP
A
Cushing’s triad (late signs)
1-increased BP
2-decreased pulse (brady)
3-decreased respirations
11
Q
n/v with brain cancer
A
-unrelated to food intake (vagal nerve stimulation)
12
Q
visual disturbances w/ brain cancer
A
-papilledema
13
Q
gold standard for detecting brain tumors
A
MRI
14
Q
PET
A
activity rather than structure
15
Q
temporal lobe fxns
A
-language, behavior, memory, emotions
16
Q
parietal lobe
A
L from R
- sensations
- reading/writing
17
Q
Temodat
A
*temozolomide
**given orally and can pass the blood brain barrier
18
Q
corticosteroids in brain cancer
A
-reduce cerebral edema
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
20
Q
how do we tx SCC
A
-relieve cord compression w/ use of IV steroids (dexamethasone) to decrease edema and inflammation/swelling
21
Q
sudden onset of neurologic deficit
A
**poss vertebral collapse associated w/ spinal cord infarction
22
Q
epilepsy dx
A
- 2 or more unprovoked seizures more than 24 hrs apart
- 1 seizure and probability of future seizures
- dx epilepsy syndrome
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
24
Q
some causes of seizures
A
- hyponatremia/hypoglycemia/dehydration
- illness (with and without increased fever)
- sleep deprivation
- stress
- menstrual cycle
25
motor seizures
tonic-clonic, and epileptic spasms
26
non-motor seizures
-seizures w/ behavior arrest
27
tonic-clonic seizures
-both sides of brain and begin with rigidity (tonic) and followed by clonic activity of all extremities (stiffening/jerking of body)
28
atonic seizures
-sudden loss of muscle tone resulting in falls or drops to ground
29
myoclonic seizures
-jerking movements of muscle group WITHOUT loss of consciousness
30
seizure caused by hypoglycemia
-rapid infusion of dextrose
31
Phenytoin
(Dilantin)
*administer in IV slowly because of effects on myocardium & potential for arrhythmia development/phlebitis
32
neuroleptanalgesic agents
-combo of opioids and sedative drugs/tranquilizer
**fentanyl (analgesic) and droperidol (tranquilizer/sedative)
33
leading cause of seizures in the elderly
- cerebrovascular disease (leading cause)
| * other risk factors: head trauma, dementia, infection, alcoholism, aging
34
Bacterial Meningitis 95% have 2 of 4
1. headache
2. fever
3. nuchial rigidity
4. altered LOC
35
clinical manifestations meningitis
- 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)
36
nursing management of meningitis
* FLUIDS and assess for dehydration/shock
| - control of seizures (common in meningitis)
37
bacterial meningitis
-droplet isolation for at least 1st 24 hrs for bacterial meningitis
38
SIADH
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
39
most common cause of viral meningitis
-enteroviruses
| poliovirus, coxsackievirus, echovirus
40
difference in viral vs bacterial meningitis
-viral meningitis NOT associated w/ altered mental status and seizure activity
41
tx for HSV / encephalitis
Acyclovir (Zorivax)
42
encephalitis symptoms
- initial: stiff neck/headache/fever/confusion
| * focal neurologic symptoms
43
gold standard HSV encephalitis dx
PCR test
44
Arboviral encephalitis
**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
45
meningeal exudate in arboviral enceph.
**compounds clinical presentation, irritating the meninges and increasing ICP
46
west nile encephalitis specific signs/symptoms
- maculopapular or morbilliform rash
- flaccid paralysis
- parkinsonian movements
47
Bell's palsy
unilateral inflammation of 7TH cranial nerve (weakness or paralysis of facial muscles of the ipsilateral (same side) of the affected facial nerve)
48
Bell's palsy other signs
- increased lacrimation (tearing)
| - painful sensations in face/behind ear/in eye of affected side
49
meds Bell's palsy
corticosteroid (reduce inflammation and ^ blood flow) and acyclovir
*heat to promote blood flow
**protect from eye injury
50
MS
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
51
myasthenia gravis
**reduction in acetylcholine receptor sites causing muscular weakness (worsens with movement and gets better with rest)
52
MG tx
* *weakness of VOLUNTARY muscles
- administration of anticholinesterase meds and immunosuppressants AND ASPIRATION RISK
* myasthenic crisis=exacerbation of MG symptoms
* cholinergic crisis=overmedication
53
Gullain-Barré Syndrome
-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)
54
autoimmune:
MG, MS, Gullain-Barre
55
GBS does not...
affect cognitive function or LOC
56
what to watch for with GBS
-impending neuromuscular respiratory failure
57
CSF and GBS
-elevated protein levels
58
Parkinson dz
TRAP (cardinal signs)
T-Tremor
R- Rigidity of muscles
A- Akinesia/Bradykinesia (without or decreased body movement)
P- Postural disturbances (gait/balance dx)
59
ALS
- Amyotrophic Lateral Sclerosis
| * loss of both upper and lower motor neurons
60
cervical disc herniation
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
61
cervical disc herniation tx
- hot/moist compresses
| - analgesic/NSAID/sedative/muscle relaxants
62
NSAIDS and cerv disc hern.
discontinue with bone fusion sx (can impede healing)
63
lumbar disc herniation
- 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)
64
lumbar disc hern. test
-straight leg-raising test
| stretches sciatic nerve and causes pain down leg
65
presbycusis
age related hearing loss
66
hearing loss can be...
(1) result of conduction prob (external ear dx)
(2) sensorineural (damage to cochlea or vestibulocochlear nerve
(3) mixed
(4) psychogenic
67
some risk factors for hearing loss
- bacterial meningitis
| - tympanic membrane perf
68
otalgia
sensations of fullness or pain with or without hearing loss
69
meds motion sickness
- antihistamines (block conduction of vestibular pathway of inner ear)
- anticholinergics (antagonize histamine response)
- may cause drowsiness/dry mouth
70
Ménière Disease
- INNER ear
| * causes vertigo, tinnitus, feeling of pressure in ear, fluctuating hearing loss
71
risk factors tinnitus
- ototoxic substances
- thyroid dz
- vit B deficiency
- hyperlipidemia
- fibromyalgia
72
BPPV
(benign paroxysmal positional vertigo)
* often caused by head trauma/infections
* sneeze/cough can trigger
73
ototoxic meds
*aminoglycoside ABx most common (gentamicin)
74
acoustic neuroma dx
MRI
75
trigeminal nerve involvement in acoustic neuroma=
- facial paralysis
- discomfort to touch
- loss of taste
76
emmetropia
normal vision
77
refractive errors
-shortened or elongated eyeball
78
myopia
nearsightedness (distant vision is blurred)
79
hyperopia
farsightedness (near vision blurred)
80
astigmatism
irregularity in the curve of the cornea
81
blindness
BCVA (best corrected visual acuity) ranging from 20/400 to no light perecption
82
Contrast-Sensitivity training
-turn on lights, if pt sees better with lights on then they may benefit from magnification
83
Glare testing
- realistic evaluation of pt's ability to see in their environment
* objects calibrated to create glare and test vision
84
normal pressure in eye
at or below 21 mm Hg
85
risk factors glaucoma
- AA
- older than 60
- DM
- cardiovasc dz
- migraines
- myopia
- eye trauma
- prolonged use corticosteroids
86
symptoms glaucoma
- HA
- seeing halos around lights
- pupil vertically oval, fixedm and nonreactive to light/accommodation
87
goal of glaucoma tx
-reduce current pressure by 30% and is lowered until stable and no signs of optic nerve damage
88
medication for glaucoma
-beta-blockers (decrease production of aqueous humor and decrease IOP)
89
cataracts
* painless BLURRY vision (surroundings are dimmer), light scattering, sensitivity to glare
* diplopia
* color shifts seeing more yellowish-brown tint
90
cataracts risk factors
- myopia/retinal detachment/infection
- corticosteroids
- chem burns
- smoking
- poor nutrition
- obesity
- dehydration
- DM
91
hyphema
bleeding into anterior chamber of eye
92
scleral buckle
retinal detachment (silicone or sponge sewn onto sclera at site of tear, holds in place until scarring seals tear
93
AMD
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
orbital trauma
-priority is preservation of vision
Assess for: displacement of eyeball, edema, hemorrhage
*cold compress in early phase then warm compress
95
leading cause of blindness among children and young adults
*ocular trauma
96
orbital cellulitis
-monitor IOP (edema, swelling)
**can result in permanent vision loss
97
enucleation
-removal of entire eye and part of optic nerve
98
evisceration
surgical removal of intraocular contents
99
exenteration
removal of eyelids, eye, and various amounts of orbital contents
100
HTN risk factor for
- CAD
- atherosclerotic cardiovasc dz
- heart failure
- stroke
- renal failure
101
HTN dz
2 or more readings taken during two or more contacts with healthcare provider
OR
-one reading SBP 210 mmHg or DBP 120 mmHg
102
secondary HTN
-fix underlying pathology
5-10%
*renal dz, hyperaldosteronism, pheochromocytoma
103
HTN crisis
- lower BP w/ IV Nipride, TG, Labetalol, Hydralazine (pregnant pts)
- but SLOWLY LOWER to prevent organ hypoperfusion
104
risk factors HTN
- diet: high Na+
- obesity: high fat
- obstructive sleep apnea
- excess alcohol
- physical inactivity
- dyslipidemia (high cholesterol)
105
HTN cardiac manifestations
- 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
HTN kidney manifestations
- increased BUN and creatinine
| - micro albuminuria (early sign of vascular damage)
107
HTN cerebrovascular manifestations
- TIA
| - stroke
108
retinal changes HTN
- hemorrhages
- exudates
- arteriolar narrowing
- cotton wool spots
- papilledema
(signs of HTN in BVs of retina)
109
secondary HTN --endocrine dx's
- 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
secondary HTN--renal dz
- Renal Parenchymal Dz
| - Narrowing of Renal Arteries
111
other causes secondary HTN
- vascular dx (Coarctation of aorta)
- neuro dx (Increased ICP)
- stress
- pregnancy
- sleep apnea
- drugs (coke, meth, oral contraceptives)
112
high Bp and brain
risk of stroke, often hemorrhagic
113
HTN complications
- renal insufficiency/failure
- encephalopathy
- headache
114
12 Lead ECG
-can show left ventricular hypertrophy (^ in QRS amplitude)
115
w/ diuretics monitor:
- Na+, K+, Mg+
- daily weight
- side effects: dry mouth, thirst, n, weak, drowsy, postural hypoTN
116
ACE inhibitors and ARBS
- monitor for persistent cough
- monitor for hyperkalemia
- monitor for angioedema
117
Beta Blockers
- monitor pts w. chronic respiratory dz
- monitor HR for brady and hypoTN
- avoid sudden discontinuation
118
Calcium Channel Blockers
*diltiazem
- monitor for reflex tachy
- administer on empty stomach
- avoid sudden discontinuation
119
vasodilators
- monitor for peripheral edema
| - monitor for s/s heart failure
120
causes hypertension crisis
- HTN poorly controlled (biggest cause)
- HTN undiagnosed
- pts discontinuing meds abruptly
121
HTN emergency
-assessment reveals actual or developing clinical dysfunction of target organ
122
gradual reduction in BP
- 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
HTN urgency associations
- severe headaches
- nosebleeds
- anxiety
**oral agents to normalize within 24-48 hrs
124
vital signs with HTN emergency/urgency
- vital signs every 5 min for rapid changing VP
| - vital signs every 15-30 if BP more stable
125
HTN and hemodynamics
- risk for decreased cardiac output
| - risk for decreased tissue perfusion
126
most common cause CVD
-atherosclerosis
127
Metabolic syndrome (6 conditions that can lead to heart dz)
* 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
diaphoretic
**can be sign of myocardial ischemia as well as n/v
129
angina is...
TRANSIENT/REVERSIBLE episode of inadequate coronary perfusion causing myocardial ischemia
130
Printzmetal's Angina
(Variant or Vasospastic) caused by coronary artery spasms....UNRELATED to activity and often at nigh
***transient/reversible--ST segment changes
131
Silent Myocardial Ischemia
- may have ECG changes on stress test
| - asymptomatic
132
Refractory Angina
-severe angina that persists with use of two or more anti-anginal meds (nitrates)
133
rule out an MI
-cardiac enzymes:
* troponin I (gold standard)
* CK-MB
* myoglobin
134
gold standard for CP
-coronary angiography or cardiac cath
135
antiplatelets for angina
aspirin/clopidogrel (plavix)
136
IIB/IIIa inhibitors
- prevent platelet aggregation
| * IV: Integrilin, Aggrastat
137
causes of myocardial infarction (MI)
- ruptured plaque
- blood clot
- severe anemia (anemic=decreased hemoglobin)
- severe vasospasm (lasts long enough to cause MI)
- cocaine induced MI
138
w/in 20 minutes MI
-initial damage starts in subendocardial layer (non Q wave infarct)
139
w/in 1-6 hrs MI
-progresses to epicardial layer
140
transmural MI
-involves death of entire thickness of myocardial wall (Q wave infarct--absence of depolarization)
141
P wave, QRS wave, T wave
P-depolarization of atria (round and precedes QRS)
QRS-represents depolarization of ventricles
T wave-represents repolarization of ventricles
142
myocardial ischemia, myocardial injury, and myocardial necrosis
* 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 wave
electrically silent area and can be sign of previous MI
-in leads V2-V3
144
decreased cardiac output symptomes
- Cerebral: decreased LOC, restless
- Cardiac: tachy, hypotension
- Respiratory: decreased O2 sat, dyspnea
- Kidney: decreased UOP
- Skin: cool, diaphoretic
- Pulses: weak
145
MONA tx MI
- Morphine
- Oxygen
- Nitrates
- Aspirin
146
Analgesics not just for pain in MI
*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
first line of tx if cardiac cath not available for MI
-fibrinolytic therapy
148
pump failure
* heart failure=20% of L ventricle damaged
| * Cardiogenic shock= 40% left V damaged
149
systolic vs diastolic heart failure
- systolic: weakened heart muscle
| - diastolic: stiff and noncompliant heart muscle
150
BNP
increase=heart failure (overstretching of L vent muscle)
151
Left Heart Failure (HFrEF)
"systolic heart failure--EF less than 40%" --> can't pump enough blood out of L ventricle
*pulmonary congestion
152
Left Heart Failure (HFpEF)
"diastolic heart failure--EF greater than 50%"
*from: resistance to filling of one or both ventricles because stiff/noncompliant leading to pulmonary congestion
153
nitrates
reduce afterload by producing arterial and venous vasodilation
154
cardiac tamponade signs
Beck's Triad
1-hypotension
2-jugular vein distension
3-muffled heart sounds (ABSENT breath sounds with pneumothorax)
155
Vtach
more than 3 PVCs in a row
156
vtach no pulse SCREAM
```
Shock
CPR
Rhythm check
*IV MEDS*
Epi
Antiarrythmitics meds (amiodarone)
```
157
PEA 6 H's
- Hypovolemia
- Hypoxia
- Hydrogen ion acidosis (assess ABG)
- Hyper/hypokalemia
- Hypoglycemia
- Hypothermia
158
PEA 6 T's
- Toxins
- Tamponade cardiac
- Tension pneumothorax
- Thrombosis Heart
- Thrombosis lung
- Trauma
159
Acute arterial occlusion 6 P's
```
Pain
Pulselessness
Pallor/cyanosis
Paralysis
Polar sensation (cold)
```
160
thoracic aorta management
- control BP (beta blocker metoprolol)
| - IV emergent nitroprusside (Nipride)
161
AAA greater than...
...4.5 cm needs surgery
162
Virchow's Triad
DVT formation
- stasis of blood
- endothelial damage/inflammation
- hypercoagulability (dehydration, smoking, anemia)
163
Coumadin
PO
-regulated before d/c and interferes with liver synthesis of vit K and some clotting factors
164
arterial ulcers vs venous ulcers
* 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
gangrene
does NOT occur w/ venous ulcers
166
primary vs secondary varicose veins
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
