Module 4 Flashcards
A person is diagnosed with an alteration in arousal. Which clinical manifestation is typical of this diagnosis?
Vomiting without nausea
An APRN knows the onset of an acute confusion state?
Sudden
Seizures are initiated by:
hyperexcitability of neurons
An APRN recalls that increased intracranial pressure can occur because of:
cerebral edema
The APRN has an areflexic patient and understands this means the person has:
no tendon reflexes
An unconscious person is admitted to the hospital after a motorcycle accident. The person experienced a brief loss of consciousness at the scene followed by an awake, lucid period of 1 hour. The APRN suspects this individual has a:
extradural hematoma
An APRN knows that spinal shock results in:
poor venous circulation
The APRN recalls fusiform aneurysms are due to
arteriosclerotic changes
A person arrives at the clinic and reports a unilateral headache for 2 days that worsens with movement and light. No trauma has occurred. The APRN suspects:
migraine headaches
An APRN recalls that increased intracranial pressure with hydrocephalus may be the result of:
reduced reabsorption of CSF
A child has meningitis. An APRN observes flexion of the knees and hips when the child’s neck is rapidly flexed forward. Which sign did the APRN observe as positive?
Brudzinski sign
Which finding will help the APRN determine whether the febrile seizure is a simple febrile seizure?
The convulsion is generalized.
The most useful treatment for brain tumors in children is:
surgical therapy
Which vaccine may have prevented the boy’s contraction of bacterial meningitis?
H. influenza
Upon physical examination, the child shows resistance to knee extension in the supine position with the knees and hips flexed against the body. Which sign is the child displaying?
Kernig
Pattern of breathing:
apneustic, cluster, and ataxic
Pupillary changes – ischemia/hypoxia
dilated
Pupillary changes – opiates
pinpoint pupils
Brain death- body cannot maintain
internal homeostasis
Brain death is irreversible cessation of the
entire brain, including brainstem and cerebellum occurs.
Brain death (EEG characteristics)
isoelectric (flat) electroencephalography (EEG) for 6-12 hours
Brain death
can no longer maintain the body’s internal homeostasis
Alterations in awareness – pathophysiology - direct
direct destruction from direct ischemia and hypoxia
Alterations in awareness – pathophysiology - indirect
indirect destruction as a result of compression
Alterations in awareness – pathophysiology
effects of toxins and chemicals of metabolic derangement
Agnosia (definition)
failure to recognize the form and nature of objects
Agnosia can be
can be tactile, visual, or auditory
Aphasia (definition)
loss of comprehension or production of language
Dysphasia
(impaired speech) – expressive vs receptive
Wernicke’s dysphagia
disturbance in understanding all language – verbal and reading comprehension
Conductive dysphagia
disruption of temporal lobe fibers with a failure to repeat words but an ability to initiate speech, writing, and reading aloud
Anomic
inability to name objects, people, numbers, or qualities
Transcoritcal dysphagia
ability to repeat and recite
Broca aphasia
xpressive dysphasia of speech and writing but with retention of comprehension
Global aphasia
involves anterior and posterior speech areas, with expressive and receptive aphasia
Delirium is 2 states
hyperkinetic confusional state
acute state of brain dysfunction
Delirium is associated with the
right middle temporal gyrus or disruption of the left temporo-occipital junction
Hyperactive delirium
agitated delirium, excited delirium syndrome
Hypoactive delirium
hypoactive confusional state, is associated with the disruption of the right-sided, frontal-basal ganglion
Epilepsy-is a recurrence of
seizures and a disorder for which no cause can be found
During a seizure, ____ & ____ are depleted and ____ is accumulated.
oxygen & glucose. Lactate acid. This is why with progressive seizure activity, there is a potential for progressive brain injury and irreversible damage.
Generalized seizures (neurons)
bilaterally
Focal (partial) seizures (neurons)
unilaterally
Epilepsy syndromes - what are the cause
genetic/developmental cause
Unclassified epileptic seizures. etiology is
unknown
what is status epilepticus
a medical emergency, continuing/recurring seizures with incomplete recovery, unrelenting seizure activity that lasts 30 minutes or more and the main concern is hypoxia as oxygen decreases when having a seizure
Huntington’s disease
Alterations in what?
Also known as
alterations in movement, also known as chorea
Huntington’ disease is rare….
autosomal dominant hereditary degenerative disorder, short arm on chromosome 4
Huntington’s disease is severe degeneration of
striatum and basal ganglia
Huntington’s disease is abnormal movements that occur
without conscious effort, emotional lability, and dementia
Parkinson’s disease – severe degeneration of
the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway
Pyramidal motor syndrome – upper
hypertonia/spasticy
Pyramidal motor syndrome - lower
hypotonia/flaccidity
ALS – amyotrophic lateral sclerosis
progressive muscle weakness leads to respiratory failure
ALS – lower motor neuron syndrome
flaccid paresis consists of a weakness of individual muscles, progressing to paralysis, hypotonia, and primary muscle atrophy (atrophy caused by denervation)
ALS – upper motor neuron syndrome
spastic paresis consists of a weakness of movement patterns, progressing to paralysis and atrophy
Moderate cerebral concussion
any loss of consciousness lasting more than 30 minutes, accompanied by post traumatic anterograde amnesia lasting 24 hrs or more
Diaphragm function may be impaired because
phrenic nerves exit at C3 to C5. Therefore an injury at C4 might impair breathing
Spinal shock - is the complete loss of
reflex function in all segments below the level of the lesion
Spinal shock manifestations
flaccid paralysis,
sensory deficit,
a disruption in thermal controls (faulty control of sweating),
transient drop in BP,
and loss of bladder and rectal control
Spinal shock may persist for
short a time as a few days or as long as 3 months
Neurogenic shock - is caused by the
absence of sympathetic activity from loss of supraspinal control and unopposed parasympathetic tone mediated by the intact vagus nerve
Autonomic hyperreflexia (dysreflexia) -
sudden massive reflex sympathetic discharge associated with a spinal cord injury at the thoracic level of T6 or above
Herniated intervertebral disk - clinical manifestation
pain radiating due to compression (called radiculopathy) along the nerve occurs
two types of cerebrovascular brain abnormalities
ischemia with/without infarction and hemorrhage
arteriovenous malformation can be
tangled vessels
tension-type headache
most common headache, mild-to-moderate bilateral headache with a sensation of a tight band around the head.
tension-type headaches
acute and chronic forms
Migraine
unilateral, photophobia, phonophobia, can last for days
Tension (location, description)
up the back of the head, gradually goes to top, feels like band around the head
Cluster (description, location)
very short, several in a day, often pain behind the eye
infection/inflammation of the central nervous system
caused by bacteria, viruses, fungi, parasites, or mycobacteria
meningitis clinical manifestation
bacterial - throbbing headache,
increasing in severity,
increasing photophobia,
nuchal rigidity,
positive Kernig sign,& positive Brudzinski,
projectile vomiting,
neck stiffness
Multiple sclerosis (CNS)
progressive, chronic, inflammatory, demyelinating, autoimmune disorder to the CNS - occurs in white and gray matter
Plexus injuries
distal to the spinal roots but proximal to the formation of peripheral nerves
Myasthenia Gravis (description)
chronic autoimmune disease, defect in nerve impulse transmission at the neuromuscular junction
Myasthenia Gravis - clinical manifestations
exertional fatigue and weakness that worsens with activity, improves with rest, and recurs with resumption of activity
Clinical manifestations of tumors/meningiomas
seizures
brain metastases - clinical manifestations
include headache, seizures, and alterations in cognition, mental status, and behavior
in fetuses, nervous system develops
middle of the third gestational week
craniosynostosis
premature close of one or more of the cranial sutures during the first 18-20 months of life
An APRN recalls the reflex withdrawal of an affected body part from painful stimuli before the pain is perceived is controlled by
myelinated A fibers
Which finding would an APRN expect to recognize during the assessment of a person with chronic pain. The person is
depressed (they burn up serotonin)
Fever is stimulated by
tumor necrosis factor-a
An APRN recalls the majority of the sleep cycle is spent in stage
N2
A person is admitted to the hospital after experiencing delusions. The APRN knows that a delusion is:
a persistent belief that is contrary to the background of the individual
Which food item would be most appropriate for a person taking a monoamine oxidase inhibitor?
ham
A patient has excessive and persistent worrying for longer than 6 months. Which diagnosis will the APRN observe documented on the chart?
generalized anxiety disorder
processing of pain - (4 stages)
transduction, transmission, perception, and modulation
neuroanatomy of pain
Myelinated A-delta -transmission is fast and causes reflex withdrawal of affected body part from stimulus before pain sensation is perceived
unmyelinated C polymodal fibers
transmission is slower and conveys dull, aching, or burning sensations
segmental inhibition
inhibitory interneuron
Acute pain is a
protective mechanism
Acute pain alerts an individual to a condition or experience that is
Immediately harmful to the body
Acute pain lasts
less than 3 months
Clinical manifestations of acute pain
sympathetic nervous notable,
tachycardia,
hypertension,
diaphoresis,
dilated pupils,
and anxiety
Acute somatic pain
arises from joints, muscle, bone, and skin
Acute visceral pain - transmitted by
C fibers and pain arises from the internal organs and lining of body cavities
Acute visceral pain - pain is
poorly localized as a result of the fewer number of nociceptors
Acute visceral pain- (description)
aching, gnawing, throbbing, or intermittent in quality
Chronic pain lasts at
least 3 months.
Is poorly understood.
Chronic pain does not respond to usual therapy.
Chronic pain serves
no protective purpose
Chronic pain is thought to be caused by
dysregulation of nociception and pain modulation processes (peripheral and central sensitization) so not easily controlled
Chronic pain - neuroplasticity
maintenance of pain (brain’s ability to form and reorganize synaptic connection in response to learning or experiencing)
Chronic pain may cause
behavioral and psychological changes, such as depression and anxiety
Chronic pain - suffering
usually increases with time
Temperature regulation: thermoregulation is controlled by the
hypothalamus
Heat is distributed by
the circulatory system
Heat is produced by
chemical reactions of metabolism and skeletal muscle tone and contraction
Vasodilation is a mechanism
of heat loss
Vasoconstriction is a mechanism
of heat conservation
Pathogenesis of fever:
temporary resetting of the hypothalamic thermostat
Benefits of fever
aids infectious response,
kills many organisms,
decreases the serum levels of iron, zinc, and copper,
deprives bacteria of food,
promotes lysosomal breakdown and autodestruction of cells
, and increases lymphocytic transformation and phagocyte motility
Tissue hypothermia
slows chemical reactions, increases blood viscosity and slows blood through the microcirculation; facilitates blood coagulation; stimulates vasoconstriction
NREM sleep
N1-light sleep-3-8%;
N2-longest stage-45-55%;
N3-slow wave sleep 13-23%
REM is (what percentage) of sleep
20-25%
REM is also known as paradoxical as the
EEG pattern is similar to that of a natural awaken pattern where the brain is very active with dreaming
Vivid dreaming occurs during
REM
REM occurs
every 90 minutes, beginning after 1-2 hours of sleep
Insomnia
inability to fall or stay asleep
Obstructive sleep apnea syndrome & restless leg syndrome
sleep disorders
Obesity hypoventilation syndrome due to
leptin resistance
Conductive hearing loss
cannot be conducted through the middle ear
Sensorineural hearing loss-can be caused by
ototoxic drugs, impaired organ of Corti or its central connections
Presbycusis is
age related hearing loss
Mixed hearing loss
combination of conductive and sensorineural losses
Functional hearing loss
no organic cause
Schizophrenia is alterations
of brain dopamine pathways
Schizophrenia - glutamate hypothesis
underactivation of glutamate receptors
Schizophrenia - type of episodes
psychotic episode, hallucinations, delusions, disorganized behavior
Schizophrenia clinical manifestations - negative symptoms
characterized by disruptions in normal emotional states and expressions
Schizophrenia clinical manifestations- cognitive symptoms
problems with thought process, inability to perform daily tasks requiring attention and planning
Schizophrenia clinical manifestations - negative dimensions
flattened affect (near absence of facial expressions or emotions); anhedonia (cannot experience emotions like pleasure or pain and feel detached from environment);
alogia (absence of speech and the ability to answer questions or express themselves);
avolition (not able to complete simple goals or tasks like bathing or dressing)
Bipolar 1
Depression with mania
bipolar 2
Depression with hypomania
Depression - deficits
in norepinephrine, dopamine, and/or serotonin, leading to depression
Mania - elevated
concentration of monoamines
PTSD -
persistent dysregulation of fear-based memory system
PTSD- DSM5 needs 6 symptoms
re-experience, avoidance, negative cognitions, and mood and arousal
A person has rhabdomyolysis. Which typical clinical manifestations will the APRN find upon assessment?
Dark urine
Which information is correct regarding the pathophysiologic process of osteomyelitis?
Osteomyelitis produces sequestrum
The primary defect in osteoarthritis is:
loss of articular cartilage
A person has gout. Which typical clinical manifestation may the APRN find upon assessment?
tophi
An infant has a positive Ortolani sign. Which condition is the infant experiencing?
development dysplasia of the hip
Structural scoliosis may be caused by:
neuromuscular disease
A preadolescent arrives at the clinic and reports pain and swelling in the left knee after playing sports. The nurse suspects:
Osgood-Schlatter disease
A child newly diagnosed with Duchenne muscular dystrophy. Because of this diagnosis, the APRN expects:
the child will be a boy
Duchenne muscular dystrophy is the most common of the muscular dystrophies and occurs only in boys. It is a progressive
weakness associated with large calf muscles that are said to be : pseudohypertrophic
What is the most likely reason why Foley catheter insertion is needed in DMD:
the patient is experiencing incontinence
Fracture classifications
complete (bone is broken all the way through), incomplete (bone is damaged but still in one piece), incomplete (
Fracture- closed or simple (complete or incomplete)
skin is intact
Fracture - open or compound (complete or incomplete)
skin is broken
Fracture-comminuted
bone breaks into more than 2 fragments
Fracture - linear
fracture runs parallel to the long axis of the bone
Fracture - oblique
fracture of the shaft of the bone is slanted
Fracture - spiral
encircles the bone
Fracture-transverse
occurs straight across the bone
Fracture - greenstick
perforates one cortex and splinters the spongy bone
Fracture-torus
cortex buckles but does not break
Fracture-bowing
longitudinal force is applied to a bone
Fracture-pathologic
break occurs at the site of a preexisting abnormality
Fracture-stress
fatigue and insufficiency, transchondral
Bone fractures clinical manifestations
impaired function,
unnatural alignment,
swelling,
muscle spasms,
tenderness, pain,
impaired sensation
Rhabdomyolysis
release of intracellular potassium into circulation creating high K levels which might require dialysis to correct if extensive
Rhabdomyolysis-protein
pigment myoglobin into extracellular space and bloodstream - causing cola colored urine
Classic triad of complications rhabdomyolysis
muscle pain, weakness, and dark urine (from myoglobin)
rhabdomyolysis - Treatment
rapid intravenous hydration
Osteomalacia -deficiency of
vitamin D lowers the absorption of calcium from the intestines, results in soft bones
Osteoarthritis-most common
form of joint disease and is a disorder of synovial joints
Osteoarthritis- inflammatory
(new evidence and cytokines) joint disease. No single patho
Osteoarthritis- loss of
articular cartilage, sclerosis of underlying bone, and formation of bone spurs (osteophytes)
Osteoarthritis - also called
degenerative joint disease
Osteoarthritis- incidence
increases with age
Osteoarthritis - leading cause of
disability in middle aged and older populations
Osteoarthritis - clinical manifestations
pain, stiffness, enlargement of the joint, tenderness, limited motion, and deformity
Osteoarthritis - clinical manifestations- nodes
joint swelling in the fingers - Heberden and Bouchard nodes
Heberden nodules
very end of the fingers, groups of 2
Bouchard nodules
in the middle of the fingers
Rheumatoid arthritis - clinical manifestations
rheumatoid nodules in organs
Ankylosing Spondylitis
chronic inflammatory joint disease in the spine or sacroiliac joints, causing stiffening and fusion of the joints
gout - clinical manifestations - pain
in the great toe (usually, but not always); worse at night often in the metatarsophalangeal joint
gout clinical manifestations - increase
in serum urate concentration, hyperuricemia
gout clinical manifestations - recurrent
attacks of monoarticular arthritis: inflammation of a single joint
gout clinical manifestations- deposits
of monosodium urate monohydrate (tophi) in and around the joints
gout clinical manifestations - renal
disease, involving glomerular, tubular, and interstitial tissues and blood vessels
gout clinical manifestations - formation
of renal stones
Polymyositis and Dermatomyositis -
inflammation of connective tissue and muscle fibers
myopathy -
a primary muscle disorder
Genu varum (arrogant cowboy)
bowlegged
genu valgum
knock kneed
Ricketts causes
insufficient vitamin D
insensitivity to vitamin D
renal wasting of vit D
inability to absorb calcium or vit D in the gut
Ricketts disorder causing
mineralization failure, “soft bones”, and skeletal deformity
Osgood-Schlatter disease
tendinitis of the anterior patellar tendon and osteochondrosis of the tubercle of the tibia
Duchenne muscular dystrophy is the
most common muscular dystrophy
Duchenne muscular dystrophy definition
poorly anchored fibers tear apart under the repeated stress of contraction,
free calcium then enters the muscle cell, causing cell death and fiber necrosis
Duchenne muscular dystrophy clinical manifestations
appear by age 3-4 years of age
gait abnormalities
progressive weakness - muscles, respiratory insufficiency, cardiomyopathy, scoliosis
Duchenne muscular dystrophy clinical manifestations
waddling gait
gower sign (climbing up the legs when rising)
cognitive dysfunction
Dermal appendages that are important in body temperature regulation are
eccrine sweat glands
Allergic contact dermatitis is associated with
delayed hypersensitivity
Which information is correct regarding acne rosacea ?
is likely an immune-mediated inflammation
A person has verrucae. Which microorganism is the causative agent?
virus
Basal cell carcinoma is associated with
depressed center and rolled borders
Acne vulgaris is
associated with excessive sebum production
Which information is correct regarding bacterial skin infections
impetigo causes small vesicles with a honey-colored crust
A child is seen at the local clinic with an erythematous maculopapular rash, high fever, enlarged lymph nodes, and a barking cough. Which diagnosis will the nurse observe documented on the chart?
rubeola
Salmon patches
result from distended dermal capillaries that fade over time
Which microorganism is the cause of the baby’s rash that is now worse in comparison to the original diaper rash?
candida albicans
Which type of medication has the healthcare provider most likely prescribed for the baby
topical antifungal
Pruritis
itching & most common symptom of primary skin disorders
atopic dermatitis is also called
atopic eczema
atopic dermatitis is common in
childhood and infancy, but can last into adult life
What is the presenting symptom of atopic dermatitis
pruritis
what is a herald patch
circular, demarcated, salmon-pink
erythema multiforme is associated with
allergic or toxic reactions to drugs or microorganisms
erythema multiforme is caused by
immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes
Bulls eye (target lesion)
erythematous regions surrounded by rings of alternating edema and inflammation
honey-crusted - impetigo is caused by what organism
staphylococcus
Tinea corporis definition
ringworm of the body
Tinea corporis characteristics of lesion
round oval or circular, central clearing with raised red borders, borders may have vesicles, papules, or pustules, scaling, itching, burning
candiadiasis is caused by
candida albicans
candiadiasis is normally found
on the skin, in the GI tract, and in the vagina
C. albicans causes thrush which is
local environment of moisture and warmth, systemic administration of antibiotics, pregnancy, diabetes mellitus, Cushing’s disease, debilitated states, age younger than 6 months, immunosuppression, and neoplastic diseases
candiadiasis clinical manifestations
thin-walled pustule that produces a whitish-yellow curd like substance
candiadiasis treatment
topical antifungal medication
seborrheic keratosis
cutaneous basal cells
actinic keratosis is
premalignant lesion composed of aberrant proliferations of epidermal keratinocytes caused by prolonged exposure to UV radiation
acne vulgaris - non-inflammatory acne - blackheads
comedones are open
acne vulgaris-non-inflammatory acne-whiteheads
comedones are closed
inflammatory acne is caused by
follicular wall rupture in closed comedones
pustules are inflammation
close to the surface
papulas and cystic nodules are inflammation
is deeper and may cause scarring
inside out-immunologic dysregulation
leading to an epidermal barrier abnormality
outside-in
explanation with primary barrier dysfunction as the cause
atopic dermatitis clinical manifestations -
frequent exacerbations, severe pruritis (itching is the hallmark sign), and characteristics eczematoid appearance with redness, edema, and scaling
atopic dermatitis in infants
rash (red scaly lesions) appearing on the face, scalp, trunk, and extensor surfaces of the arms and legs
atopic dermatitis in children and adults
tendency of rash to appear on the neck, antecubital, and popliteal fossae, hands and feet
atopic dermatitis common lab finding
eosinophilia
Lichenification is the
thickening of the epidermis from constant scratching
atopic dermatitis is common
with adults with chronic eczema
irritant contact dermatitis
candida infection (diaper rash)
skin infection caused by bacteria
impetigo
impetigo contagiosum is a
common condition in children
impetigo transmission is by
both direct and indirect contacts
impetigo is characterized by
honey-crusted lesions
impetigo is a superficial infection usually caused by
staphylococcus aureus or streptococcus pyogenes
impetigo incidence is high
in hot,humid climates
impetigo types
nonbullous and bullous
bullous impetigo produces
staphylococci produce a bacterial toxin called exfoliative toxin (ET)
bullous impetigo causes a disruption
in desmosomal adhesion molecules with blister formation
molluscum contagiosum is
pox-like scales, highly contagious
rubeola red measles clinical manifestations
high fever
malaise
enlarged lymph nodes
runny nose
conjunctivitis
barking cough
rubeola red measles skin description
erythematous purple to red or brown maculopapular rash, developing over the head and spreading distally over the trunk, extremities, hands and feet
rubeola red measles - Koplik spots
mouth lesions- pinpoint white spots surrounded by an erythematous ring over the buccal mucosa, lasts 3-5 days
what help the prevention of rubeola ?
vaccines
rubeola red measles treatment
same as rubella (vaccine)
roseola is
erythematous, nonpruritic macular rash that lasts approximately 24-48 hours and develops over trunk, neck, and arms
chicken pox/varicella is the same as
herpes zoster (shingles)
chickenpox both diseases are produced by
the same virus
varicella-zoster virus (VZV) is a
deoxyribonucleic acid (DNA) virus
chickenpox infection occurs within the
keratinocytes
chickenpox is highly contagious
spread by person to person contact and airborne droplets
chickenpox clinical manifestations -
itching or the appearance of vesicles, usually on the trunk, scalp or face; later spreading to the extremities
chicken pox clinical manifestations lesions
in various stages of maturation with macules, papules, and vesicles present in a particular area at the same time
children chickenpox clinical manifestations
children with chickenpox are at risk for developing shingles as an adult
who does hand/foot/mouth disease affect
infants and young children
hand/foot/mouth disease is caused by
coxsackievirus
hand/foot/mouth disease clinical manifestations
fever
vesicular ulcerous lesions in the mouth
vesicular rashes on hands, feet, buttocks,
meningitis
encephalitis
acute flaccid paralysis
neuro respiratory syndrome
hand/foot/mouth disease treatment
supportive care
Scabies is a contagious disease caused by
the itch mite, sarcoptes scabiei
Scabies is transmitted by
personal contact and infected clothing and linens
scabies - female mites
tunnels into the stratum corneum and deposits eggs
scabies primary lesions -
burrows, papules, and vesicular lesions with severe itching (worse at night)
scabies treatment
scabicide or oral ivermectin (for severe scabies), all clothing/linens must be washed in hot cycles or dry cleaned
