Med Surg Final Flashcards
What are the s/s of trigeminal neuralgia?
sudden, intense unilateral facial pain, tearing of the eye and freq blinking
Treatment of trigeminal neuralgia
Anticonvulsants (tegretol and trileptal) Sugery: 1. local nerve block 2. Glycerol Rhizotomy 3. Microvascular decompression
What do we need to know about anticonvulsants (especially tegretol)
- must use tegretol cautiously because it can further damage the liver
- must assess alcohol intake
- assess liver enzymes
Diet for Trigeminal Neuralgia
high protein, high calorie diet that is warm and easy to chew
How can we tell if the meds for trigeminal neuralgia are effective?
if they are performing social activities
What are things that we need to assess for, for our patients with trigeminal neuralgia?
- if they are eating (I&O)q
- if they are performing oral care
Pt teaching after glycerol rhizotomy?
pt may have to do facial exercises to improve their facial muscles
What CN has inflammation in Bell’s Palsy?
CN VII (facial)
What can be the first presentation of bell’s palsy?
herpes/pain around the ear
S/s of Bell’s Palsy
- unilateral paralysis of facial muscles
- unilateral loss of taste and hearing
- possible tearing
What meds are used to MANAGE Bell’s Palsy?
corticosteriods (for 2 weeks) + acyclovir
Non-Medical interventions for ball’s palsy
- moist heat and gentle massage
- eye patch and artificial tears ( to avoid eye abrasions)
- oral care
Guillian_Barre Syndrome
ascending, symmetric paralysis that usually affects cranial nerves and the PNS
What are the s/s of Guillian Barre Syndrome?
bilateral weakness, pain (worse at night), paresthesia, hypotonia, areflexia => paralysis
How do you “diagnose” GBS?
r/o MS
- lumbar puncture
- EMG- dec nerve conduction velocity
Treatment for GBS?
- plasmapheresis
- IV sandoglobulin
IV sandoglobulin
immunoglobulin
** must keep pt hydrated because it affects renal fucntion
Complications of GBS?
- respiratory depression!!!
- orthostatic hypotension
- HTN
- bradycardia, dysrhythmias
- DVT
- Pressure shore
- UTI
- incontinence/retention
- small bowel obstruction
What might be an indicator that someone with GBS might require intubation?
continuous drooling of saliva
Above what vertebrae will the pt lose their ability to breathe on their own?
C4 and above
What 2 vertebrae might you be able to move your arms?
C7 and T1
When are you concerned with autonomic dysreflexia?
above T6
Spinal Shock
happens immediately (complete loss of skeletal muscle function) - dec reflexes, loss of sensation, flaccid paralysis below lvl of injury
When is there a higher risk for GI prob (small bowel obstruction, paralytic ileum, bladder distention)
above T5
Reglan
helps with the delayed gastric emptying
poikilothermism (thermoregulation)
ability to shiver and ability to sweat
Cervical injury below C4
diaphragmatic breathing if phrenic nerve is still functioning
How do we know if spinal shock is resolving
- return of reflexes
What medications do you give someone with a spinal cord injury?
- methylprednisolone (give early and in large doses) Must be within EIGHT hours of injury
- must be diluted and given IV
Non-operative care for a SCI
- traction/realignment- halo vest
Surgical Care for a SCI
- decompression laminectomy
What must you assess for after a decompression laminectomy?
- dusky skin or trouble breathing
- hoarseness will indicate a knick on the pharynx
What are the s/s of autonomic dysreflexia?
- throbbing HA
- bradycardia
- HTN
- blurred vision
- diaphoresis and flushing of the skin above the lesion
- piloerection
- nausea
- sudden nasal congestion
Nursing intervention for autonomic dysreflexia?
- sit them up (or elevate 45 degrees)
- address cause
- call doc
