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NCLEX: Med Surg > Nervous System > Flashcards

Nervous System Flashcards

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1
Q

What part of the nervous system is composed of the brain and spinal cord?

A

Central nervous system (CNS)

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2
Q

What part of the nervous system is composed of the cranial nerves, spinal nerves, and autonomic nervous system?

A

Peripheral nervous system

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3
Q

Basic unit of the nervous system

A

Neuron — transmits impulses

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4
Q

Sensory neurons control sensation and are _________ meaning they transmit messages from the PNS to CNS

A

Afferent

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5
Q

Motor neurons control mobility and are _________ meaning they transmit messages from the CNS to the PNS

A

Efferent

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6
Q

Fatty substance that surrounds and insulates the axon in a neuron and promotes faster transmission of impulses

A

Myelin sheath

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7
Q

Largest part of the brain that controls motor, cognitive, and sensory function

A

Cerebrum (2 hemispheres — R and L)

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8
Q

Structure that connects the L and R hemispheres of the cerebrum

A

Corpus callosum

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9
Q

The left hemisphere controls the _____ side of the body, while the right hemisphere controls the _____ side of the body

A

Right; Left

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10
Q

Outer layer of the cerebrum composed of gray matter

A

Cerebral cortex

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11
Q

The motor cortex is found in the _________ lobe of the brain

A

Frontal

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12
Q

Which lobe of the brain controls memory, speech and language, personality, and decision-making

A

Frontal

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13
Q

_________ area is located in the frontal lobe and is essential for speech function

A

Broca’s

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14
Q

The sensory cortex is found within the _________ lobe of the brain

A

Parietal

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15
Q

The _________ lobe of the brain is essential for interpreting signal related to things such as touch, position, pain, temperature

A

Parietal

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16
Q

The visual cortex is found within the _________ lobe of the brain

A

Occipital

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17
Q

The _________ lobe of the brain is essential for visual processing and interpretation

A

Occipital

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18
Q

The auditory cortex is found within the _________ lobe of the brain

A

Temporal

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19
Q

The _________ lobe of the brain is essential for hearing and recognizing language

A

Temporal

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20
Q

_________ area is found within the temporal lobe of the brain and is essential for the comprehension of verbal and written language

A

Wernicke’s

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21
Q

Structure located at the back of the brain beneath the occipital and temporal lobes essential for coordinating muscle movements and maintaining posture and balance

A

Cerebellum

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22
Q

Structure of the brain essential for regulating autonomic functions such as breathing, HR, and digestion

A

Brainstem

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23
Q

The spinal cord terminates around ___ or ___

A

L1; L2

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24
Q

Membrane the surrounds the brain and the spinal cord

A

Meninges

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25
Q

What are the three layers of the meninges

A

Dura mater, arachnoid mater, pia mater

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26
Q

Space between the skull/vertebrae and the dura mater

A

Epidural space

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27
Q

Space between the dura mater and the arachnoid mater

A

Subdural space

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28
Q

Space between the arachnoid mater and pia mater

A

Subarachnoid space

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29
Q

Cerebral spinal fluid (CSF) circulates in the _________ space

A

Subarachnoid

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30
Q

_____ helps to surround and cushion the CNS and provides nutrients and eliminates waste products from the nervous system

A

CSF

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31
Q

The _________ nervous helps to maintain homeostasis in the body by innervating smooth muscle, cardiac muscle, and several glands

A

Autonomic

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32
Q

Components of the autonomic nervous system

A

Sympathetic and parasympathetic nervous systems

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33
Q

The _________ nervous system is responsible for controlling the body’s fight or flight response

A

Sympathetic

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34
Q

The nerves of the sympathetic nervous system originate between ___ and ___ in the spinal cord

A

T1; L2

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35
Q

Effects of the SNS

A

Increased CO, vasoconstriction and increased BP, bronchodilation, pupil dilation, decreased secretions and peristalsis

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36
Q

The _________ system controls the body’s rest and digest response

A

Parasympathetic (PSNS)

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37
Q

Nerves associated with the PSNS originate between ___ and ___ in the spinal cord

A

S2; S4

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38
Q

Effect of the PSNS

A

Decreased CO, vasodilation and decreased BP, bronchoconstriction, pupil constriction, increased secretions and peristalsis

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39
Q

Diagnostic that allows for visualization of the cerebral blood vessels to check for blockages and other abnormalities; catheter is typically inserted at femoral artery at the groin and is threaded up through the blood vessels to the brain

A

Cerebral angiogram

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40
Q

Cerebral angiogram pre-procedure nursing care

A

Ensure patient has been NPO for 4-6 hrs, assess for allergy to contrast dye, assess kidney function, assess and mark pulses distal to insertion site

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41
Q

Cerebral angiogram post-procedure nursing care

A

Check insertion site for bleeding, advise patient to keep leg straight, perform neurovascular assessment distal to insertion site (pulses, cap refill, temp, color), encourage patient to increase fluid intake

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42
Q

Diagnostic used to identify seizures, sleep disorders, and encephalopathy; electrodes are placed on patient’s scalp and electrical activity of brain is recorded

A

Electroencephalogram (EEG)

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43
Q

EEG pre-procedure nursing care

A

Have patient wash hair so electrodes stick to scalp, educate patient to arrive sleep-deprived (easier to diagnose epilepsy), advise patient to avoid stimulants or sedative medications, NPO is NOT required (anesthesia not used)

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44
Q

EEG intra-procedure nursing care

A

Educate patient that hyperventilation or strobe lighting may be used to increase likelihood of seizure activity

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45
Q

Invasive procedure where device is inserted into cranial cavity to measure ICP

A

Intracranial pressure (ICP) monitoring

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46
Q

ICP monitoring is done in the OR and carries a major risk for

A

Infection

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47
Q

Indications for ICP monitoring

A

Glasgow coma scale <8

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48
Q

Normal ICP

A

10-15 mmHg

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49
Q

S/S of increased ICP

A

Initially: restlessness, irritability, headache
Progression: decreased LOC, pupil abnormalities, abnormal breathing patterns (Cheyne-stokes, BOS), abnormal posture (decerebrate, decorticate)

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50
Q

Diagnostic by which cerebral spinal sample is obtained from spinal canal and is analyzed for suspected meningitis, subarachnoid hemorrhage, and other neurological disorders

A

Lumbar puncture

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51
Q

Lumbar puncture pre-procedure nursing care

A

Have patient empty their bladder, position patient on side in fetal position OR sit up and leaned over a table (either way, patient’s back should be arched)

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52
Q

Lumbar puncture post-procedure nursing care

A

Instruct patient to lie flat for several hours and increase fluid intake, monitor for signs of CSF leak (severe headache!)

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53
Q

MRI pre-procedure nursing care

A

Assess for history of claustrophobic (administer anti-anxiety if needed), instruct patient to remove all jewelry, assess for contraindications such as metal implants (artificial joints, pacemaker), provide patient with earplugs

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54
Q

S/S of migraine headaches

A

Unilateral throbbing head pain, N/V, photophobia (light sensitivity), phonophobia (sensitivity to noise), aura

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55
Q

Treatment for mild and moderate migraines headaches

A

Mild: NSAIDs
Moderate: ergotamine, sumatriptan

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56
Q

Migraine headache patient education

A

Lay in dark, quiet environment, avoid triggers

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57
Q

S/S of cluster headaches

A

Severe unilateral NON-throbbing head pain typically around orbital region, nasal congestion, facial sweating, droopy eyelid and excess tearing, agitation and pacing

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58
Q

Cluster headache treatment

A

Ergotamine, sumatriptan, oxygen therapy, corticosteroids, verapamil

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59
Q

Seizure risk factors

A

Fever, cerebral edema, infections like meningitis, fluid and electrolyte imbalances (hyponatremia), drug or alcohol withdrawal)

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60
Q

Seizure characterized by three phases: tonic episode (stiffening of muscles and loss of consciousness), clonic episode (1-2 min or rhythmic jerking of extremities), postictal phase (confusion, sleepiness, agitation)

A

Tonic-clonic (grand-mal)

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61
Q

Seizure characterized by loss of consciousness for a few seconds, resembles day-dreaming. Other symptoms include picking at clothes, lip smacking, and eye fluttering

A

Absence seizure

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62
Q

Seizure characterized by brief jerking of the extremities (usually no loss of consciousness)

A

Myoclonic seizure

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63
Q

Seizure characterized by loss of muscle tone (often results in falling if patient is standing)

A

Atonic seizure

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64
Q

Examples of medications used to treat seizures

A

Valproic acid, carbamazepine, phenytoin

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65
Q

Seizure nursing care

A

If patient is standing or sitting, lower them to the floor or bed and turn them to their side. Loosen restrictive clothing, do NOT place anything in their mouth or restrain the patient, note the onset and duration of seizure

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66
Q

Post-seizure nursing care

A

Assess vital signs and neuro status, reorient patient, implement seizure precautions if not already done, determine possible triggers

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67
Q

Life-threatening complication of seizures characterized by prolonged seizure lasting more than 5 minutes or the failure to regain consciousness between seizures

A

Status epilepticus

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68
Q

Status epiplepticus risk factors

A

CNS infection, head trauma, drug withdrawal or toxicity

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69
Q

Status epilepticus treatment

A

Antiepileptics (Phenytoin), Benzos (lorazepam), anesthetics (propofol), barbiturates (phenobarbital)

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70
Q

Status epilepticus nursing care

A

Maintain patent airway and administer O2 as prescribed (PRIORITY!), administer appropriate medications, assist with intubation

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71
Q

Meningitis risk factors

A

Crowded conditions (dorms, prisons), immunosuppression, travel exposure

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72
Q

Meningitis prevention

A

Infants: HIB, PCV vaccination
Teens: meningitis vaccine (A & B) BEFORE college

73
Q

S/S of meningitis

A

Headache, fever, N/V, nuchal rigidity (neck stiffness), photophobia, positive brudzinski sign (severe pain resulting in flexion of knees and hips when attempting to push head toward chest) and positive kernig sign (severe pain when attempting to straighten knee from flexed position), altered mental status, tachycardia, seizures

74
Q

Meningitis

A

Lumbar puncture, CSF analysis

75
Q

CSF analysis findings for BACTERIAL meningitis

A

Cloudy, decreased glucose, increased protein and WBCC, positive gram stain

76
Q

CSF analysis findings for VIRAL meningitis

A

Clear, normal glucose, slight increase in protein and WBCC, negative gram stain

77
Q

Meningitis treatment

A

Antibiotics (for bacterial), analgesics, anticonvulsants

78
Q

Meningitis nursing care

A

Implement DROPLET precautions (remain of droplet for first 24 hr with antibiotic therapy), implement seizure precautions, monitor neurological status, provide quiet room with dim lights, minimize ICP (maintain HOB at 30 degrees, maintain head at midline, minimize suctioning)

79
Q

Parkinson’s disease is characterized by _________ dopamine and _________ acetylcholine

A

Decreased; increased

80
Q

S/S of Parkinson’s disease

A

Muscle rigidity, tremor, slow shuffling gait, postural instability (risk for falls), akinesia, bradykinesia, mask-like expression, drooling, Dysphagia (risk for aspiration pneumonia)

81
Q

Parkinson’s disease treatment

A

Levodopa-carbidopa (increases dopamine), Benztropine (decreases acetylcholine)

82
Q

Parkinson’s disease nursing care

A

Monitor swallowing and food intake, thicken liquids, sit patient upright, advise patient to tuck chin while swallowing, keep suction equipment at bedside, encourage ROM exercises, assist with ADLs, implement fall precautions

83
Q

A gradual, irreversible form of dementia that causes memory problems, judgement issues, and changes in personality

A

Alzheimer’s

84
Q

Alzheimer’s patho

A

Formation of beta-amyloid deposits and neurofibrillary tangles in brain causing impaired communication between neurons and brain

85
Q

Alzheimer’s risk factors

A

Older age, family hx, cardiovascular disease

86
Q

Stage 1 (mild) symptoms of Alzheimer’s

A

Forgetfulness, short-term memory loss, mild cognitive impairment

87
Q

Stage 2 (moderate) symptoms of Alzheimer’s

A

Disorientation, agitation, wandering, incontinence, ADL assistance may be necessary

88
Q

Stage 3 (severe) symptoms of Alzheimer’s

A

Bedridden, lose ability to talk, control movement, and swallow

89
Q

Definitive diagnosis of Alzheimer’s

A

Occurs after death through examination of brain tissue

90
Q

Alzheimer’s treatment

A

No cure; Donepezil (improves cognition), antipsychotics, antidepressants, anti-anxiety

91
Q

Alzheimer’s nursing care

A

Maintain structured environment, provide short directions and repetition and reorientation as needed, avoid overstimulation, use single-day calendar, maintain routine toileting schedule

92
Q

Alzheimer’s home safety measures

A

Remove scatter rugs, install door locks out of sight and reach to prevent wandering, provide good lighting especially over stairs, tape edges of stairs, remove clutter

93
Q

A progressive brain disorder that causes uncontrolled movement, emotional problems, and dementia

A

Huntington’s disease

94
Q

Huntington’s is an _________ _________ genetic disorder

A

Autosomal dominant

95
Q

S/S of Huntington’s

A

Chorea (abnormal or excessive involuntary movements), cognitive issues such as dementia, memory loss, and poor impulse control, and psychiatric issues such as depression, mania, and personality changes

96
Q

Huntington’s treatment

A

No cure; manage symptoms with psychotropic agents and tetrabenazine (decreases symptoms of chorea)

97
Q

A _________ spinal cord injury results in the loss of all nerve function below the level of the injury

A

Complete

98
Q

_________ spinal cord injuries allow for some function below the level of the injury

A

Incomplete

99
Q

S/S of spinal cord injury

A

Loss of motor function, loss of sensation, loss of reflexes, loss of bowel or bladder function

100
Q

A spinal cord injury below the level of ___ causes paraplegia (paralysis or paresis/weakness) of the lower extremities

A

T1

101
Q

A spinal cord injury to the __________ region causes quadriplegia resulting in paralysis or paresis of all four extremities

A

Cervical

102
Q

A spinal cord injury to the _________ motor neurons results in hypertonia (spastic muscle tone and spastic neurogenic bladder)

A

Upper (above L1 or L2)

103
Q

A spinal cord injury to the _________ motor neurons results in hypotonia (flaccid muscle tone and flaccid neurogenic bladder)

A

Lower (below L1 or L2)

104
Q

Spinal cord injury nursing care

A

Stabilize the spine, maintain patent airway, monitor for complications such as hemorrhage, neurogenic shock, and autonomic dysreflexia

105
Q

A patient who has had a spinal cord injury at the level of ___ or above is at risk for respiratory dysfunction

A

C4

106
Q

Nursing care for patients with halo traction device (common in patients with spinal cord injury to cervical region)

A

Move patient as a unit, do NOT apply pressure to rods, ensure there is a wrench or screwdriver attached to the vest for removal of vest in the event of an emergency

107
Q

Neurogenic shock typically occurs with a spinal cord injury above

A

T6

108
Q

Key symptoms of neurogenic shock

A

Hypotension, bradycardia, flushed and warm skin

109
Q

Treatment of neurogenic shock

A

IV fluids, vasopressors, atropine

110
Q

Life-threatening hypertension following a spinal cord injury triggered by stimuli below the level of injury such as distended bladder

A

Autonomic dysreflexia

111
Q

S/S of autonomic dysreflexia

A

Extreme hypertension, severe headache, blurred vision, diaphoresis

112
Q

Autonomic dysreflexia nursing care

A

Sit the patient upright (PRIORITY!), notify provider, loosen restrictive clothing, address underlying cause (check catheter tubing for kinks, manually disimpact patient if d/t fecal impaction), administer Antihypertensives and closely monitor BP

113
Q

An autoimmune disorder that affects the central nervous system and causes damage to the myelin sheath and underlying nerves resulting in inflammation and formation of scar tissue or plaques

A

Multiple sclerosis (MS)

114
Q

T or F: MS is characterized by periods of relapse and remission

A

True

115
Q

MS risk factors

A

Women, ages 20-40

116
Q

S/S of MS

A

Vision issues such as diplopia and nystagmus, muscle spasticity and/or weakness, balance issues, bowel and bladder dysfunction, fatigue, cognitive changes such as difficulty concentration, emotional changes such as depression or anxiety, pain, Dysphagia

117
Q

MS diagnosis

A

MRI, lumbar puncture and CSF analysis (elevated protein)

118
Q

MS treatment

A

Immunosuppressants (corticosteroids), interferon beta, anti-inflammatories, muscle relaxants

119
Q

MS patient education

A

Avoid triggers (temp extremes, stress, fatigue, illness)

120
Q

Neurodegenerative disease that causes gradual deterioration of upper and lower motor neurons resulting in loss of voluntary movement and muscle control. Patients will eventually lose their ability to speak, eat, move, and breathe.

A

Amyotrophic Lateral Sclerosis (ALS)

121
Q

S/S of ALS

A

Muscle weakness and atrophy, muscle cramps and twitching, Dysphagia, respiratory paralysis (between 3-5 years of diagnosis)

122
Q

ALS treatment

A

No cure; riluzole (helps slow deterioration of motor neurons)

123
Q

ALS nursing care

A

Maintain patent airway (PRIORITY!), monitor for pneumonia and respiratory failure (ventilator will eventually be necessary)

124
Q

Autoimmune disorder that affects the peripheral nervous system causing sudden onset of weakness and paralysis

A

Guillain-Barre Syndrome (GBS)

125
Q

GBS risk factors

A

Previous viral infections such as influenza or pneumonia

126
Q

S/S of GBS

A

Tingling in hands and feet, symmetric weakness (both sides), decreased DTRs, paralysis; symptoms usually occur at the feet and move up the body

127
Q

GBS treatment

A

Plasmapharesis (filters blood, removes antibodies attacking nerves), IV immunoglobulin

128
Q

GBS nursing care

A

Maintain patent airway, monitor for aspiration, pneumonia, and respiratory failure

129
Q

Autoimmune disorder that causes severe muscle weakness and is characterized by period of exacerbation and remission. This disorder results from antibodies blocking and destroying acetylcholine receptors at the neuromuscular junction

A

Myasthenia Gravis (MG)

130
Q

S/S of MG

A

Muscle weakness that is worse with exercise and improved with rest, diplopia, Dysphagia, SOB, thymus hyperplasia (enlarged thymus gland), drooping eyelids (ptosis)**

131
Q

Interpretation of edrophonium/Tensilon test for diagnosis of MG and differentiation between MG and cholinergic crisis

A

Edrophonium is a cholinergic agent that increases levels of acetylcholine
MG: if administration of edrophonium improves patient condition, then they have MG
Cholinergic crisis: if administration of edrophonium worsens patient condition, then patient is experiencing a cholinergic crisis; administer atropine!

132
Q

MG treatment

A

Cholinergic agents such as Neostigmine and pyridostigmine, immunosuppressants such as prednisone, Plasmapharesis, thymectomy

133
Q

MG nursing care

A

Maintain patent airway, assist with ambulation, encourage rest periods, provide patient with frequent, small high-calorie meals, monitor for aspiration and choking, administer eye drops and tape eyes shut at night to prevent drying and irritation

134
Q

Ruptured arteries and aneurysms in the brain can cause a _________ stroke

A

Hemorrhagic

135
Q

_________ strokes are caused by a blood clot

A

Ischemic

136
Q

Stroke risk factors

A

Smoking, HTN, DM, afib, hyperlipidemia, previous TIA

137
Q

Temporary blockage of blood flow to the brain

A

Transient ischemic attack (TIA)

138
Q

S/S of stroke

A

Unilateral limb weakness, facial dripping, slurred speech, dizziness, visual disturbances

139
Q

A stroke on the _____ side of the brain can cause expressive aphasia meaning that the patient will have the inability to speak or understand language and difficulty with reading or writing

A

Left

140
Q

A stroke on the left side of the body will cause _____-sided weakness or paralysis

A

Right

141
Q

A stroke on the _____ side of the brain can cause poor judgement and impulse control and overestimation of abilities

A

Right

142
Q

A right sided stroke leads to _____-sided weakness or paralysis

A

Left

143
Q

Treatment for ischemic stroke

A

Thrombolytics such as alteplase (tPA) within 3 hours of onset of symptoms**, anticoagulants and antiplatelets

144
Q

Treatment for hemorrhagic stroke

A

Antihypertensives agents

145
Q

Stroke nursing care

A

Implement fall precautions, assess swallowing ability and gag reflex before eating anything, advise patient to tuck chin against chest to facilitate swallowing, reposition patient frequently, advise patient to use scanning technique in order to see everything (if the patient has homonymous hemianopsia)

146
Q

S/S of TBI

A

Related to an increase in ICP: decreased LOC, Cushing’s triad, confusion, headache, pupil abnormalities, N/V, seizures, abnormal posturing

147
Q

Cushing’s triad

A

Systolic hypertension (widened pulse pressure), bradycardia, irregular breathing

148
Q

TBI treatment

A

Mannitol, hypertonic saline, pentobarbital (induces coma and decreases metabolic demands), anticonvulsants, opioid analgesics

149
Q

TBI nursing care

A

Stabilize patient’s cervical spine, maintain patent airway, monitor vitals and LOC, take measures to decreases ICP (hyperventilation, avoid suction, HOB at 30 degrees or more, ensure head stays midline). If patient is conscious and alert, advise them to avoid coughing, blowing nose, and extreme flexion or extension of neck

150
Q

Complication of TBI characterized by downward movement of brain tissue that occurs due to cerebral edema

A

Brain herniation

151
Q

S/S of brain herniation

A

Fixed/dilated pupils, decreased LOC, abnormal respirations, abnormal posturing

152
Q

Arterial bleeding between the skull and dura mater

A

Epidural hematoma

153
Q

Venous bleeding between the dura mater and arachnoid mater

A

Subdural hematoma

154
Q

The accumulation of blood within the brain tissue

A

Intracerebral hemorrhaging

155
Q

Lens opacity that impairs vision

A

Cataracts

156
Q

What is the number one risk factors for cataracts

A

Aging

157
Q

S/S of cataracts

A

Gradual, painless loss of vision, blurry vision, diplopia, white or graying of pupil, absent red reflex

158
Q

Post-cataract surgery patient education

A

Number of eye drops will be used (antibiotic, steroid, NSAID) several times a day, advise patient to wear dark sunglasses when outside, avoid activities that can increase IOP (bending at waist, sneezing, coughing, blowing nose, lifting over 10lb, straining with bowel movements), educate patient that best vision occurs around 4-6 weeks

159
Q

_____-angle glaucoma is more common and is caused by aqueous humor overproduction or a decrease in outflow resulting in a gradual increase in IOP

A

Open

160
Q

_________-angle glaucoma is caused by forward displacement of the iris obstructing the angle between the iris and the cornea resulting in complete blockage of aqueous humor outflow and rapid increase in IOP

A

Closed

161
Q

Glaucoma risk factors

A

Aging, genetics, diabetes, hypertension

162
Q

S/S of open-angle glaucoma

A

Loss of peripheral vision**, mild aching in eyes, headache

163
Q

S/S of closed-angle glaucoma

A

Severe eye pain, N/V, blurred vision, halos around lights, reddened sclera

164
Q

Normal intraocular pressure (IOP)

A

10-21 mmHg

165
Q

Glaucoma treatment

A

Mannitol, eye drops (timolol, Acetazolamide, brimonidine, travaprost; this will decrease aqueous humor production or improving outflow)

166
Q

Deterioration of the macula (part of the retina) resulting in loss of central vision

A

Macular degeneration

167
Q

Type of macular degeneration that is more common and is causes by clumps of protein called drusen that grow under the macula and cause the macula to become thinner and dry out

A

Dry

168
Q

Type of macular degeneration in which abnormal blood vessels grow under retina and leak blood or fluid into macula causing scarring. This type has a faster onset

A

Wet

169
Q

Macular degeneration patient education

A

Smoking cessation, wear sunglasses, follow-up care with provider, home modifications for safety d/t loss of central vision

170
Q

Macular degeneration treatment

A

No cure; photodynamic therapy for wet macular degeneration

171
Q

Separation of the retina from the underlying epithelium d/t build-up of vitreous humor behind retina

A

Retinal detachment

172
Q

Retinal detachment risk factors

A

Aging, injury, family hx, previous intraocular surgery, ocular tumors

173
Q

S/S of retinal detachment

A

Floaters, flashing lights, sudden painless sensation of current being drawn over visual field

174
Q

Retinal detachment treatment

A

Emergency surgery to repair detached retina

175
Q

Inner ear disorder that causes issues with hearing and balance

A

Ménière’s disease

176
Q

What are the three key symptoms of Ménière’s disease?

A

Tinnitus, unilateral sensorineural hearing loss, vertigo

177
Q

Ménière’s disease risk factors

A

Genetics, infection, ototoxic medications

178
Q

Ménière’s disease treatment

A

Supportive: antihistamines, anticholinergics, diuretics, antiemetics
Labyrinthectomy (educate patient that this will result in complete hearing loss on affected side!)**

179
Q

Ménière’s disease patient education

A

Avoid caffeine, smoking, and alcohol; restrict salt intake, distribute fluid intake evenly throughout the day

NCLEX: Med Surg (5 decks)

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