👩🏾🎓- Neuro, HIV, Immunity Test Flashcards
Autonomic NS
Regulates involuntary body functions
Further broken down into sympathetic and parasympathetic NS
Monro-kellie doctrine of hypothesis
Brain tissue, blood and CSF occupy the skull, when one increases the other components must decrease to maintain equilibrium
Sympathetic NS
Fight or flight
- Elevates ❤️ rate
- Increased respiratory rate, dilates pupils, shunts blood to the skeletal muscles and skin
- slows digestion
Parasympathetic NS
- slows ❤️ rate
- lowers BP, decreases respirations, shunts blood from the periphery to internal organs
- constricts pupils and digest food
Rest and digest
Myasthenia gravis
Epidemiology, causes, triggers
Epidemiology- motor disorder characterized by fluctuating, localized skeletal muscle weakness and fatigue
Causes- may have familial link, thymus gland abnormalities, hyperthyroidism link, drug induced
Triggers- medications, alcohol, stress, infection, heat, surgery, cathartics
Myasthenia gravis key features
- progressive proximal muscle weakness
- weakness improves with rest
- occulAr changes (ptosis, diplopia, incomplete eye closure)
- poor posture
- respiratory compromise
- loss of bowel/bladder control
Bulbar symptoms
Clinical manifestation of myasthenia gravis
Symptoms involving cranial nerves that emerge from the medulla of the brain stem
CN IX, X, XI, XII
Results in difficulty with phonation, chewing and swallowing
Cranial nerves IX X XI XII
IX glossopharyngeal - controls some muscles used in swallowing and taste
X vagus- sensory, motor and autonomic functions of viscera (glands, digestion, heart rate)
XI spinal accessory- controls muscles used in head movement
XII hypoglossal- controls muscles of tongue
Repetitive nerve stimulation
Evaluates neuromuscular transmission & measures action potential after repeated nerve stimulations
In MG decreased muscle response with repetitive stimulation
Name two medications contraindicated in MG patients
Magnesium and CA channel blockers
Cholinesterase inhibitors (anticholinesterase)
Tensilon
Prostigmin (IV)
Mestinon (oral)
How do you administer meds for patients with MG
Give medications on time
Provide food 1 hour AFTER meds
Myasthenia crisis vs cholinergic crisis
Myasthenia crisis
Not enough Ach. Presents as ⬆️❤️ rate, flaccid muscles, pale/cool skin. Treat by administering cholinesterase inhibitors
Cholinergic crisis
Too much Ach causes muscle fatigue. Presents as ⬇️❤️ rate, fasciculations, sweating, pallor, excessive secretions, small pupils. Treat by holding cholinesterase inhibitors and give anticholinergics
Tensilon rest results
Muscle strength improvement = myasthenia crisis
Fasciculations & weakness = cholinergic crisis
Causes of Guillain-Barré syndrome
Campylobacter jejuni is most frequent cause
Cytomegalovirus , Epstein-Barr virus , mycoplasma pneumonia and haemophilus influenzae
Paroxysmal
Sudden recurrence of intensification or symptoms
Tic douloureux
Risk factors, triggers, management
Trigeminal neuralgia
Pain in the distribution of the trigeminal Nerve
Risk factors- increased BP and MS
Triggers- touching an area of skin or brushing the teeth, drinking a beverage, smiling, talking, cool air
Management- gabapentin, carbamazepine, antiepileptic drugs
baclofen in patients with MS acts as a muscle relaxant
Spondylolysis bs spondylolisthesis
Spondylolysis- structural abnormality of vertebral facet
Spondylolisthesis- proximal vertebrae slides forward
Radiculopathy
Acute nerve root compression
Herniated nucleus pulposus
Pathophysiology, complications, surgical management
Pathophysiology- weakening of or a tear in the annulus fibrosus. Radiculopathy
Complications- numbness/weakness, loss of bowel and bladder control, saddle anesthesia
Surgical management- laminotomy, microdisectomy, spinal fusion, bone graft, artificial disk replacement
Multiple sclerosis
Pathophysiology, manifestations
Pathophysiology- immune system attacks the brain and spinal cord
Manifestations- numbness or weakness in limbs, partial or complete vision loss, tingling or pain, tremor, lack of coordination, unsteady gait, fatigue and dizziness
MS key features
- muscle weakness and spams
- fatigue
- dysmetria
- ataxia
- hypgesia
- dysarthria
- scotomas
- vertigo
- tinnitus & heading loss
- sexual dysfunction
- cognitive changes (late)
Define the following terms
Hypalgesia, dysmetria, dysarthria, scotomas
Hypalgesia- decreased sensitivity to painful stimuli
Dysmetria- inability to judge distance or scale
Dysarthria- difficulty speaking
Scotomas- partial loss of vision or a blind spot
Multiple sclerosis
Triggers, complications
Triggers- extreme temperatures, overexertion, stress, humidity, infections
Complications- muscle stiffness or spasms, paralysis often in the legs, problems with bladder/bowel/sexual dysfunction, mental status changes (memory loss, problems concentrating) depressions, seizures
Amyotrophic lateral sclerosis
Pathophysiology, manifestations
Pathophysiology- affects voluntary muscle control. Progressive degenerative disease of motor neurons in the brain and body
Manifestations- muscle cramp or stiffness, muscle weakness, slurred speech and difficulty swallowing
Upper motor vs lower motor neuron
Upper motor neuron - damage associated with spasticity. The nerves within the cord that carry messages from the brain to the spinal nerves
Lower motor neuron - damage associated with flaccidity. Spinal nerves that branch out from the spinal cord to specific areas of the body
What does the phrenic Nerve innervate
The diaphragm
Anterior cord syndrome
Kept/lost
Kept- touch, position, vibration
Lost- motor, pain, temp
Posterior cord lesion
Kept/lost
Kept- motor
Lost- vibration, touch, position
Central cord syndrome (most common)
Kept/lost
Kept- position, vibration, touch (variable)
Lost- motor function (loss is more extensive in upper extremities)
Brown sequard syndrome
Ipsi/contra-lateral
Occurs when one lateral half of spinal cord is affected
Lost ipsilateral- motor, position, vibration, deep touch
Lost contralateral- pain, temperature, light touch
Ipsilateral vs contralateral
Ipsilateral- on the same side as the injury
Contralateral- on the opposite side of the injury
Cervical, thoracic, lumbar SCI
Cervical- inability to breathe and quadriplegia
Thoracic- paraplegia
Lumbar- decreased control of legs, bowel/bladder function and sexual function
Positive vs negative inotropes
Used in sci
Positive- strengthen the force of the ❤️ beat
Negative- weaken the force of the ❤️ beat
Spinal shock
Occurs immediately after injury
Compete but temporary loss or depression of all or most spinal reflexes as well as sensory, motor autonomic activity below the injury
Brain unable to transmit signals to muscles and organs, resulting in loss of sensation, movement, and other body functions
What indicates the end of spinal shock
Can last from 24 hours to 1-6 weeks and return of reflex activity below the level of injury
Neurogenic shock
A type of distributive shock that occurs in patients with brain, upper thoracic and cervical injuries.
Caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls
Results in ⬇️ cardiac output, bradycardia and hypotension
Autonomic dysreflexia
Reflex hypertension in patients with injury above T5-T6 level.
Observe for rapid increase in BP ; remove the stimulus that initiated
Stimulus- full bladder, full bowel, pain
List the 4 nurses roles immediately after spinal cord injury
1 stabilize the spine
2 treat the trauma (maintain airway, cpr, manage hemorrhage
3 assess neuro status for current baseline: GCS, motor, sensory, cognitive
4 ask: what happened, did they lose consciousness, were they moved, what was baseline neurological status
What is the treatment for neurogenic shock
Fluid resuscitation
Inotropics: dopamine, dobutamine
Vasopressors: vasopressin, norepinephrine, phenylephrine
Tumor grading
Classification based of cellular characteristics
Grade 1- well differentiated tumor, closely resembles tissue of origin in structure/function
Grade 4- poorly differentiated, does not clearly resemble the tissue of origin in structure/function
Tumor staging
TNM
Classification based in size of tumor and if metastasis present
T- extent of primary tumor (size)
N- number of regional lymph nodes involved
M- extent of metastasis
7 warning signs of cancer
C - change in bowel/bladder habits
A- a sore that doesn’t heal
U- unusual bleeding or discharge
T- thickening or lump in breast, etc
I- indigestion or difficulty swallowing
O- obvious changes in a wart or mole
N- nagging cough or hoarseness
Nursing care for external radiation
- gently wash skin with mild soap
- don’t wash off treatment markings
- pat skin dry
- use powders, ointments, lotions, creams prescribed by oncologist
- wear soft loose clothing
- avoid sun exposure
- avoid heat exposure
Nursing care internal radiation
- private room
- sign “caution radioactive material”
- keep door closed
- limit visitors to 10-30mins
- stay 6ft away from client
- no pregnant women
- no children < 16yrs
Side effects of radiation
Local skin changes and hair loss
Altered taste and fatigue
Taste, swallowing, xerostomia (dry mouth)
Bone (can lead to fractures)
Alkylating agents
Tx: lung, breast, leukemia, lymphoma, multiple myeloma
Action: directly damages dna to prevent cell reproduction, work in ALL PHASES of cell cycle
Route: IV/po
SE: n/v, alopecia, STERILITY, leukopenia, HEMORRHAGIC CISTIS (urine has blood), myelosuppression (7-14 days), cardio toxicity with high doses, oral mucositis, NEUROTOXICITY
Ex: CYTOXAN (cyclophosphamide)& cisplatin
Antimetabolites
Tx: breast, lung, lymphomas, brain, gi, leukemia, pancreatic
Action: interferes with dna and rna growth, damage cells during the S PHASE
Route: IV/topical
SE: n/v, alopecia, STOMATITS (gi), leukopenia, bone marrow suppression, hepatic and renal dysfunction, diarrhea, photosensitivity
Ex: 5-FU or 5-Fluorouracil, Methotrexate
Antimitotic agents
Tx: breast, lung, cervix, sarcomas, lymphomas, Wilm’s tumor
Action: stop mitosis and prevents cell reproduction, work during the M PHASE of cell cycle, but can damage cells in ALL PHASES
route: IV
SE: n/v, alopecia , constipation, EXTRAVASATION (vesicant-destroys tissue if IV leaks) NEUROTOXICITY (paresthesia), leukopenia, mild myelosuppression
Ex: Vincristine (Oncovin)
Antitumor antibiotics
Tx: breast, lung, lymphoma, esophageal, gi, Head & neck, kaposi sarcoma, melanoma’s m, pancreatic, testicular
Action: damage the cells dna and interrupts dna or rna synthesis, are cell cycle specific and work in the s phase
Route: IV/vessicant
SE: n/v, alopecia, RED URINE, cardiotoxicity, pulmonary, myelosuppression, vesicant
Ex: adriamycin (doxorubicin), bleomycin (blenoxane)
Biologic response modifiers
Immunotherapy
Tx: melanomas, renal, ovarian, skin
Action: stimulate immune system to destroy non-self CA cells & stimulates bone marrow production
Route: IV
SE: generalized inflammation (fever, chills, rigors, flu-like symptoms), PERIPHERAL NEUROPATHY, dry skin, itching and peeling
Ex: cytokines (interleukins & interferons)
Targeted therapy
Tx: many tumors w/ identified targets
Action: proteins are identified that are needed for cell division and are blocked
Route: po, eye drops
SE: vary depending on med- diarrhea and liver problems, skin rashes, delayed wound healing & hypertension
Ex: tyrosine kinase inhibitors (gleevec), multikinase inhibitors (sutent), proteasome inhibitors (velcade)
Hormonal agents
Tx: used in breast, prostate, endometrial
Action: sex hormones, or hormone-like drugs, that alter the action or production of female or male hormones deprives estrogen-sensitive tumors/or blocks testosterone synthesis
Route: oral
SE: n/v, chest or facial hair, no menstrual period, HYPERCALCEMIA, hepatic dysfunction, venous thromboembolism
Ex: tamoxifen (nolvadex)
Photodynamic therapy
Tx: used in ocular tumors, gi tumors, lung CA affecting airway
Action: selective destruction of CA cells or shrinks tumors, an agent given IV that sensitizes CA cells to light, laser light used
SE: must protect SKIN and EYES from light for 3 months
Teach: avoid light sources & avoid drugs that are photosensitizing
Absolute neutrophil (granulocyte) count ANC
Formula, normal range
ANC= WBC x (% segs + % bands)
Less than 1500 (mild)
Less than 1000 (moderate)
Less than 500 (severe)
Normal range: 1500-8000
Nadir
In relation to bone marrow
The lowest point in bone marrow suppression after chemotherapy (mainly WBC & platelets)
The nadir time is usually about 10 days after treatment
Blood counts return to normal within 3-4 weeks
The next dose of chemotherapy is given only after a persons blood counts have left the nadir and recovered to a safe level
Platelet count: thrombocytopenia
Mild, moderate, severe, normal range
Low platelet count in blood
Mild: 50k-100k
Moderate: 20k-50k
Severe: <20k
Normal range: 140k-450k
Name something that triggers DIC
Sepsis with gram-negative infections
Syndrome of inappropriate antidiuretic hormone
S&S, treatment
-no pee-
Antidiuretic hormone is secreted by posterior pituitary gland
Brain tumors are most common cause
⬇️ Na levels (hemodilution)
S&S: weakness, muscle cramps, weight gain, pulmonary edema, personality changes, confusion, seizures, HTN, heart failure, coma & death
Treatment: monitor for S&S if fluid overload, limit fluids, increase Na intake
S&S of fluid overload
Bounding pulse
Neck vein distention
Crackles in lungs
Peripheral edema
Decreased urinary output
Tumor lysis syndrome
Treatment
- due to radiation or chemo induced cell destruction
- kidneys unable to excrete large volumes of released cellular metabolites
- leads to electrolyte imbalances: HYPERKALEMIA & HYPERURICEMIA
- patients at risk following radiation/chemo; up to one week after therapy completed
Treatment: hydration (3000ml before, during and up to 3 days after treatment)
Self tolerance
Recognizing self from non-self proteins to prevent healthy body cells from being destroyed along with invaders
Shift to the left
The number of immature neutrophils released from the bone marrow has increased, usually more than segs
Often found in a patient with an acute inflammatory process such as appendicitis or cholecystitis
Segs vs bands
Segs- mature neutrophils
Bands- immature neutrophils
List 4 types of medications that can produce neutropenia
Some antibiotics , lithium , phenothiazines (often used as antiemtics) and tricyclic antidepressants
antineoplastic drugs produce bone marrow depression and can significantly lower the neutrophil count
B-lymphocytes
Antibody-mediated immunity
Antibodies rate produced by sensitizing B lymphocytes
Most long lasting immunity
Why some illnesses only occur once (b-cells) recognize antigen as non self
Active immunity
Natural or artificial
Build own antibodies, long term immunity
Natural active- you get sick (b lymphocyte)
Artificial active- immunizations
Passive immunity
Natural or artificial
Donated antibodies, temporary immunity
Natural passive- breast milk/placenta
Artificial passive- rabies shot
S&S of hiv
-Flu like symptoms:
Fever, fatigue, night sweats, chills, headache, muscle aches, lymphadenopathy (swollen lymph nodes), diarrhea, sore throat
-lymphocytopenia (⬇️ lymphocytes)
Hiv/aids classifications
Normal range cd4 count
Stage 1- cd4 count > 500 (asymptomatic)
Stage 2- cd4 count between 200-499 (asymptomatic)
Stage 3- cd4 count < 200 + OI = AIDS
Normal range: 800-1500
Pneumocystic carinii/jiroveci pneumonia
S&S , treatment, nursing care
Fungal/protozoan infection
S&S- nonproductive dry cough, crackles, dyspnea, tachypnea, Fever, fatigue and weight loss (insidious)
Treatment- Bactrim or Septra
Nursing care- monitor respiratory status, fever management, oxygen, energy conservation/⬇️ O2 demand
Mycobacterium tuberculosis and hiv
S&S
S&S- cough, dyspnea, chest pain, fever, chills, night sweats, anorexia
Cd4 count < 200 won’t have a positive PPD (must confirm with sputum or chest X-ray)
Kaposi’s Sarcoma
Rash
Co-infection with herpes
Dx: biopsy
Tx: antiretroviral therapy, chemotherapy, radiation
Leukoencephalopathy
AIDS dementia complex
Infection of the brain/CNS
Memory impairment/personality changes, hallucinations, loss of balance, slower response
ELISA test vs Western blot
ELISA- screening test that requires a blood sample be sent to a lab. Can give a false positive because it picks up other viral infections
Western blot- detects specific antibodies to hiv , used to confirm Elisa
Orasure
The only FDA approved HIV antibody test
Draws blood-derived fluids from the gum tissue
Not a saliva test
What 2 immunizations are contraindicated in hiv
MMR and chickenpox
no live viruses
HIV drug therapy
HAART, NRTI, NNRTI, protease inhibitors, fusion inhibitors, entry inhibitors, integrate inhibitors
HAART- 3 different cell interruption drugs in 1 cocktail
NRTI/NNRTI- prevent RNA from changing to DNA
Protease inhibitors- prevent exit from cell
Fusion inhibitors
Entry inhibitors
Integrate inhibitors- prevent from going into nucleus/growing
Hairy leukoplakia
White lesions on the lateral aspect of tongue
Associated with hiv
Sjögren’s syndrome and caplan’s syndrome
Sjögren’s syndrome - triad of symptoms:
Dry eyes (sicca syndrome)
Dry mouth (xerostomia)
Dry vagina
Caplan’s syndrome- rheumatoid modules in lungs and pneumoconiosis (a restrictive lung disease noted primarily in coal miners and asbestos removal workers)
RA systemic complications
- weight loss, fever and extreme fatigue
- exacerbation with remissions
- subcutaneous nodules (non-tender & movable)
- vasculitis
- periungual lesions (brownish nailbeds)
- paresthesia (burning or tingling)
- pulmonary complications
- eye complications (iritis or scleritis)
- osteopenia (⬇️ bone density)
- pleuritis & pericarditis
Swan neck deformity vs boutonnière deformity
Swan neck deformity- deformed position of the finder, joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it
Boutonnière deformity- deformed position of finders or goes, joint nearest knuckle is permanently bent toward the palm while the farthest joint is bent back away
Lunar deviation
Hand deformity in which the swelling of the metacarpophalangeal joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger
What is something important to note about biologic response modifier drugs to treat arthritis
PPD rest given before administration and should be negative
Ex: etanercept (embrel), remicaide, humira
Side effects of methotrexate
Used to treat RA
Liver toxicity
Bone marrow depression- ⬇️ WBC and platelets
Immunosuppression issues- infection 4-6 weeks for medication to start showing pain control
STRICT BIRTH CONTROL is advised - can cause stillbirth & defects
Folic acid (prevents oral ulcers)
Avoid alcohol (liver toxic)
Clinical manifestations of rheumatoid arthritis
Early- joint stiffness, swelling, pain, fatigue, generalized weakness and morning stiffness, anorexia/weight loss, persistent low grade fever, joint involvement is bilateral & symmetric
