Med Surg Midterm 1 Flashcards
Major center for regulation, maintaining homeostasis, regulation of organs
Hypothalamus
Normal reflex rating, brisk, none, very strong
Normal 2, brisk 3, none 2, very strong 4
Agnosia
Can’t id objects, people
Dementia
Chronic state, no cure
Delirium
Cns damage, increase temp, dehydration, reversible
Paroxysmal
Uncontrolled electrical discharge of brain neurons. Most seizures sudden, transient. Often associated w other conditions, not epilepsy then.
Seizures causes
Fever, brain issues, metabolic disorders, hypoxia, stroke, tumor, fluid accumulation in brain, toxins, withdrawal, drugs, sleep deprivation
Partial seizure
Starts in 1 part of brain, can be simple or complex. Person remains alert.
Generalized seizures
Involving whole brain.
Tonic
Loss consciousness, apnea, dilated pupils, lasts 15-60 sec. muscles contracted.
Clonic
Jerking, lasts 60-90 sec, hyperventilating, inhibitory neurons interrupt seizure discharge.
Postictal
Deep sleep, sore, dysphagia, variabile time, hours.
Seizure response
Turn on side. Time seizure. Don’t grab, restrain. Suction available. Loosen clothes. Bed low, padded side rail. O2. Document.
Seizure dx
EEG, no sleep 24hrs, blood labs. Ct and mri for structural problems.
Epilepsy
Spontaneous unprovoked recurrence caused by chronic underlying condition. Causes: idiopathic, acquired/hypoxemia.
Tx epilepsy
Tx meds by weight, sudden withdrawal can cause^ in seizures/status e. Take meds on empty stomach not w other meds, no etoh. Dilantin, tegratol. Ketogenic diet= 4:1 fats : protein. Surgery: subdural grids, vagal nerve stimulator.
Dx epilepsy
EEG, ct, mri, spect. Tox screen, genetics, lumber puncture for csf check.
Nystagmus
Rapid eye movements
Status epilepticus def
Every 15-30 min. 911. Respiratory interruption, arrest. Hypoxemia. Can lead to anoxia, cerebral edema, brain damage, death. Causes: withdrawal, fever, infection, fever over 104, uncontrolled epilepsy, od w narcan reversal too fast.
Status E tx
Et tube/ not when seized, o2, meds IV, monitor eeg, vs, labs esp glucose. Suction, side lying. Barbiturates, Valium, anesthesia, Dilantin. Watch respiratory, cardiac.
Sheehan syndrome
Pituitary gland dies. Hormone replacement for life. Can result from status e.
Parkinson’s s and s
Gradual onset of muscular stimulation . Tremors at rest, bradykinesia, psych changes, mask face, micrographic , shuffles, monotone, difficult swallowing, about 50% get dementia. Pill rolling, low libido, tired, constipation, pain, soft voice.
Parkinson’s tx
Teach family to suction. Rn should feed. Thickened fluids. Carbidopa-levodopa, works in 45 min. Take meds 30min to hr before eating so pt can swallow. Beta blockers. No specific tests to dx, ct and mri to rule out structural issues. Surgery: palidotomy, stimulation, stem cell implant. Keep moving, use wide base, sliding shoes. Increase fiber, fluids. Increase spices, eat high calories several times day.
Parkinson’s cause
Decreased dopamine means decrease nerve impulses. Genetics, toxins. Part of basal ganglia degenerated.
Multiple sclerosis def and causes
Autoimmune. Attacking brain, spinal cord. Demyelination of nerves. Many types. Mostly women, 20-40. First shows up in eye damage. Permanent damage, impacts mobility, gait. Genetic component, maybe viral.
MS s and s
Numb, weak limbs. Vision loss, double. Shock sensation, fatigue, ataxia. Dizzy, slurs, paralysis. Mental changes, depression. Abn reflexes. Epilepsy.
MS risks
Dm1, inflammatory bowel, smoking, thyroid issues.
MS tx
No cure. Adls w out fatigue is goal. Meds: cytotoxins, antiviral, muscle relaxers: baclephan, pain meds, help w elimination meds. Plasmaphoresis (for all autoimmune) plasma exchanges to remove antibodies. Pt. Check sugar. Self cath. Keep moving. Avoid temp extreme. Increase fluids and protein and carbs, decrease gluten and fats. Oral mj. Bowel protocol. Eye patch for double vision. Relaxation methods.
MS dx
Based on s and s, hx. Test pulmonary function, spinal tap, mri.
Myasthenia gravis def and causes
Breakdown in com between muscle and nerve. Weakness. Autoimmune. Antibodies attacking receptor sites at neural junction. AcH is there but can’t transmit. Thymus tumor for 15%. Genetics. Trigger: fatigue, stress, meds. Men over 60. Women under 40. Thyroid issues.
Myasthenia gravis s and s
Weaknesses starts at top and goes down. Ptosis: drooping eyelids. Pt stronger in am. Expression , speech impaired. Swallow impaired. No effect on sensation or reflexes. Respiratory weakness.
Myasthenia gravis dx
Coordination improvement w rest. Tensilon test admin to see increased strength w in 1 hr eyes open = positive(or ice pack). Blood test for antibodies. Nerve testing. Scan for thymus tumor. Pulmonary function tests.
Myasthenia gravis tx
Anticholinesterase. Steroids. Immunosuppressant. Plasmaphoresis. IV immunoglobulin G. Thymectomy. Monochromatic antibodies. Take meds 30min to hr before eating.
Myasthenia gravis crisis
Acute weakness in chest muscles. Need vent. Blood filtration. Aspiration. Respiratory problems.
Gillian-barre syndrome def and causes
Autoimmune, destroyer of nerve myelin. Acute, segmental demyelination of peripheral/cranial nerves. Remyelinization in recovery. Starts from bottom and goes up. Causes: immune system stimulation, infection, flu, immunization.
Guillain-b s and s
Begins w hyporeflexia, muscle weakness of lower extremities, goes up. Can impact breathing, need vent. Optic, voice impaired. Dysphagia. Orthostatic hypotension. Abn vagal responses. Retention urine, feces. Credae: squeezes out bladder. BP, heart rate fluctuates. Paralyzed. Pain, numbness.
Gullain -b dx
Pt hx, s and s, spinal tap for elevated protein after 7-10. Emg and other nerve tests.
Guillain-b tx
Rom, check bedsores, check ht rate and BP. High protein diet post vent. Meds for BP, tachycardia. Tpn feedings, check glucose. Trach set, ekg, vent at bedside. Check for respiratory distress. Plasmaphoresis.
Antigen
Foreign substance
Immunoglobulin involves in allergic reactions
IgE
1 allergies
Hay fever, allergic rhinitis , asthma
Atopic dermatitis
Genetic, increase in histamines , itches
Dermatitis medicamentosa
Drug reactions, stops when med is d/c, sudden rash
Urticaria, angioneurotic edema
Large areas hives
Hereditary angioedema
More severe, no itch, tx epi, steroids , gi issues
Latex allergic also to
Banana, avocado , kiwis, pineapple, passion fruit, chestnut. Spina bifita often allergic.
Primary chemical mediators
Have initial, immediate effect on vessels. Histamine w in 15min for max, hives, runny nose, bronchioconstriction. Eosinophils, inhibitors of some histamine reactions. Platelet activating factor, bronchoconstrictor, nose runs. Prostaglandins, sm muscle contractions, vasodilation, fever and pain. Mediated by IgE.
Secondary chemical mediators
Response to 1st, primary wave. Initiates inflammation process. Leukotrienes. Bradykinin, vasodilatior, decreases BP, edema, pain. Serotonins, vasoconstrictor, contraction of bronchi.
Hypersensitivity type 1
Anaphylactic. Insects bites, drugs, foods, allergy shots. stridor. Decrease in BP, local hives, rhinitis, angioedema, asthma. systemic, give o2, throat closes.
Hypersensitivity type 2
Cytotoxic , transfusions reaction, baby in utero, thrombocytopenia, rbc destruction.
Hypersensitivity , immune complex type 3
Immune complex type 3. serum sickness: joints, kidney, RA, lupus, hives, fever, rash.
Hypersensitivity type IV
Delayed type. Tissue damage, hasimoto, contact dermatitis.
Allergies dx
Blood work, eosinophils count, IgE levels. Skin tests. Provocative testing. Radioallergosorbent : rast .
Epi pen size normal, large . Dose.
Normal 0.3, large 0.5. dose 1 to 1000
Allergies tx
Antihistamines, epinephrine, mast cell stabilization, steroids, immunotherapy 3-4 years. DNA vaccines, isoforms, monoclonal antibody, plasmaphoresis (can cause shock, can decrease Ca from blood). O2 mask, full blast.
Autoimmune diseases list
Lupus, scleroderma, ms, myasthenia gravis, guillian b, ra, type 1 diabetes. Many more.
Autoimmune triggers
Stress, hormones, metals, foods, pesticides, toxins.
Antibodies formed by
Lymphocytes and plasma cells
Autoimmune diet
No dairy, grains, tomatoes, potatoes, peppers. Can have meats, some veggies.
Lupus def and causes
Autoimmune. Chronic inflammation of connective tissue. Increased production of antibodies. Causes drug, genetics, hormones, environmental, viruses, sunburn. Types SEL, Discoid LE= skin only. Mild or deadly. Abn b and T cells.
Lupus s and s
Sudden onset. More in women, aa and Asian. Multiple organs. Morning stiffness. Photosensitive. Pericarditis, Raynaud’s phenomena. Renal damages. Scaling. Hair loss. Fatigue, fever, behavior changes. Sob. Seizures. Englarged lymph nodes. Abd discomfort. Mallor rash. Eral ulcers.
Lupus dx
Antismith antibodies test. A and A positive in 90%.
Lupus tx
Prevent progression. Aspirin ok, minimize steroids. No sun. Immunosuppressant, antirhumatic, no smoking. Antimalerial. Heat and cold. Fish oil, vit d. Dhea.
HIV def, causes
Reverse transcriptase, retro virus. Progressive destruction of lymphocytes, cd4 (T cells. )
Normal cd4 (t cell) count
800-1300 normal. Under 500 not good. Under 200 opportunistic infection. Under 50 close to death.
Goals of art
Decrease viral load, increase cd4, delay opportunistic infection.
Pregnant mom w hiv, baby?
Mom gets hiv when pregnant, baby?
Preg w hiv, baby born positive but in 6 months negative.
Gets hiv when pregnant, baby stays positive.
3 stages hiv
1= acute, 2-3 weeks post exposure. Very contagious. 2= latency, low levels, may last decades. At end T cells down. 3= aids. T cells below 200. Survival 3 years.
Globally live w hiv
In USA
40 million
1.2 million
Hiv transmitted
Blood, semen, rectal/vag fluids, breast milk. W other stds 3x chance-for transmitting.
Hiv dx
ELISA first and western blot if positive. Can take 2 months to detect. P24 for viral load, blood bank testing.
