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Tests various > 👩🏾‍🎓- Neuro, HIV, Immunity Test > Flashcards

👩🏾‍🎓- Neuro, HIV, Immunity Test Flashcards

1
Q

Autonomic NS

A

Regulates involuntary body functions

Further broken down into sympathetic and parasympathetic NS

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2
Q

Sympathetic NS

A

Fight or flight

  • Elevates ❤️ rate
  • Increased respiratory rate, dilates pupils, shunts blood to the skeletal muscles and skin
  • slows digestion
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3
Q

Parasympathetic NS

A
  • slows ❤️ rate
  • lowers BP, decreases respirations, shunts blood from the periphery to internal organs
  • constricts pupils and digest food

Rest and digest

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4
Q

Myasthenia gravis

Epidemiology, causes, triggers

A

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

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5
Q

Myasthenia gravis key features

A
  • progressive proximal muscle weakness
  • weakness improves with rest
  • occulAr changes (ptosis, diplopia, incomplete eye closure)
  • poor posture
  • respiratory compromise
  • loss of bowel/bladder control
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6
Q

Bulbar symptoms

A

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

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7
Q

Cranial nerves IX X XI XII

A

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

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8
Q

Repetitive nerve stimulation

A

Evaluates neuromuscular transmission & measures action potential after repeated nerve stimulations

In MG decreased muscle response with repetitive stimulation

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9
Q

Name two medications contraindicated in MG patients

A

Magnesium and CA channel blockers

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10
Q

Cholinesterase inhibitors (anticholinesterase)

A

Tensilon

Prostigmin (IV)

Mestinon (oral)

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11
Q

How do you administer meds for patients with MG

A

Give medications on time

Provide food 1 hour AFTER meds

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12
Q

Myasthenia crisis vs cholinergic crisis

A

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

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13
Q

Tensilon rest results

A

Muscle strength improvement = myasthenia crisis

Fasciculations & weakness = cholinergic crisis

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14
Q

Causes of Guillain-Barré syndrome

A

Campylobacter jejuni is most frequent cause

Cytomegalovirus , Epstein-Barr virus , mycoplasma pneumonia and haemophilus influenzae

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15
Q

Paroxysmal

A

Sudden recurrence of intensification or symptoms

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16
Q

Tic douloureux

Risk factors, triggers, management

A

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

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17
Q

Spondylolysis bs spondylolisthesis

A

Spondylolysis- structural abnormality of vertebral facet

Spondylolisthesis- proximal vertebrae slides forward

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18
Q

Radiculopathy

A

Acute nerve root compression

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19
Q

Herniated nucleus pulposus

Pathophysiology, complications, surgical management

A

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

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20
Q

Multiple sclerosis

Pathophysiology, manifestations

A

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

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21
Q

MS key features

A
  • muscle weakness and spams
  • fatigue
  • dysmetria
  • ataxia
  • hypgesia
  • dysarthria
  • scotomas
  • vertigo
  • tinnitus & heading loss
  • sexual dysfunction
  • cognitive changes (late)
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22
Q

Define the following terms

Hypalgesia, dysmetria, dysarthria, scotomas

A

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

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23
Q

Multiple sclerosis

Triggers, complications

A

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

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24
Q

Amyotrophic lateral sclerosis

Pathophysiology, manifestations

A

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

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25
Q

Upper motor vs lower motor neuron

A

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

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26
Q

What does the phrenic Nerve innervate

A

The diaphragm

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27
Q

Anterior cord syndrome

Kept/lost

A

Kept- touch, position, vibration

Lost- motor, pain, temp

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28
Q

Posterior cord lesion

Kept/lost

A

Kept- motor

Lost- vibration, touch, position

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29
Q

Central cord syndrome (most common)

Kept/lost

A

Kept- position, vibration, touch (variable)

Lost- motor function (loss is more extensive in upper extremities)

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30
Q

Brown sequard syndrome

Ipsi/contra-lateral

A

Occurs when one lateral half of spinal cord is affected

Lost ipsilateral- motor, position, vibration, deep touch

Lost contralateral- pain, temperature, light touch

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31
Q

Ipsilateral vs contralateral

A

Ipsilateral- on the same side as the injury

Contralateral- on the opposite side of the injury

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32
Q

Cervical, thoracic, lumbar SCI

A

Cervical- inability to breathe and quadriplegia

Thoracic- paraplegia

Lumbar- decreased control of legs, bowel/bladder function and sexual function

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33
Q

Positive vs negative inotropes

Used in sci

A

Positive- strengthen the force of the ❤️ beat

Negative- weaken the force of the ❤️ beat

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34
Q

Spinal shock

A

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

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35
Q

What indicates the end of spinal shock

A

Can last from 24 hours to 1-6 weeks and return of reflex activity below the level of injury

36
Q

Neurogenic shock

A

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

37
Q

Autonomic dysreflexia

A

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

38
Q

List the 4 nurses roles immediately after spinal cord injury

A

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

39
Q

What is the treatment for neurogenic shock

A

Fluid resuscitation

Inotropics: dopamine, dobutamine

Vasopressors: vasopressin, norepinephrine, phenylephrine

40
Q

Tumor grading

A

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

41
Q

Tumor staging

TNM

A

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

42
Q

7 warning signs of cancer

A

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

43
Q

Nursing care for external radiation

A
  • 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
44
Q

Nursing care internal radiation

A
  • 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
45
Q

Side effects of radiation

A

Local skin changes and hair loss

Altered taste and fatigue

Taste, swallowing, xerostomia (dry mouth)

Bone (can lead to fractures)

46
Q

Alkylating agents

A

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

47
Q

Antimetabolites

A

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

48
Q

Antimitotic agents

A

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)

49
Q

Antitumor antibiotics

A

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)

50
Q

Biologic response modifiers

Immunotherapy

A

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)

51
Q

Targeted therapy

A

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)

52
Q

Hormonal agents

A

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)

53
Q

Photodynamic therapy

A

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

54
Q

Absolute neutrophil (granulocyte) count ANC

Formula, normal range

A

ANC= WBC x (% segs + % bands)

Less than 1500 (mild)
Less than 1000 (moderate)
Less than 500 (severe)

Normal range: 1500-8000

55
Q

Nadir

In relation to bone marrow

A

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

56
Q

Platelet count: thrombocytopenia

Mild, moderate, severe, normal range

A

Low platelet count in blood

Mild: 50k-100k
Moderate: 20k-50k
Severe: <20k

Normal range: 140k-450k

57
Q

Name something that triggers DIC

A

Sepsis with gram-negative infections

58
Q

Syndrome of inappropriate antidiuretic hormone

S&S, treatment

A

-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

59
Q

S&S of fluid overload

A

Bounding pulse

Neck vein distention

Crackles in lungs

Peripheral edema

Decreased urinary output

60
Q

Tumor lysis syndrome

Treatment

A
  • 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)

61
Q

Self tolerance

A

Recognizing self from non-self proteins to prevent healthy body cells from being destroyed along with invaders

62
Q

Shift to the left

A

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

63
Q

Segs vs bands

A

Segs- mature neutrophils

Bands- immature neutrophils

64
Q

List 4 types of medications that can produce neutropenia

A

Some antibiotics , lithium , phenothiazines (often used as antiemtics) and tricyclic antidepressants

antineoplastic drugs produce bone marrow depression and can significantly lower the neutrophil count

65
Q

B-lymphocytes

Antibody-mediated immunity

A

Antibodies rate produced by sensitizing B lymphocytes

Most long lasting immunity

Why some illnesses only occur once (b-cells) recognize antigen as non self

66
Q

Active immunity

Natural or artificial

A

Build own antibodies, long term immunity

Natural active- you get sick (b lymphocyte)
Artificial active- immunizations

67
Q

Passive immunity

Natural or artificial

A

Donated antibodies, temporary immunity

Natural passive- breast milk/placenta
Artificial passive- rabies shot

68
Q

S&S of hiv

A

-Flu like symptoms:

Fever, fatigue, night sweats, chills, headache, muscle aches, lymphadenopathy (swollen lymph nodes), diarrhea, sore throat

-lymphocytopenia (⬇️ lymphocytes)

69
Q

Hiv/aids classifications

Normal range cd4 count

A

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

70
Q

Pneumocystic carinii/jiroveci pneumonia

S&S , treatment, nursing care

A

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

71
Q

Mycobacterium tuberculosis and hiv

S&S

A

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)

72
Q

Kaposi’s Sarcoma

A

Rash

Co-infection with herpes

Dx: biopsy

Tx: antiretroviral therapy, chemotherapy, radiation

73
Q

Leukoencephalopathy

AIDS dementia complex

A

Infection of the brain/CNS

Memory impairment/personality changes, hallucinations, loss of balance, slower response

74
Q

ELISA test vs Western blot

A

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

75
Q

Orasure

A

The only FDA approved HIV antibody test

Draws blood-derived fluids from the gum tissue

Not a saliva test

76
Q

What 2 immunizations are contraindicated in hiv

A

MMR and chickenpox

no live viruses

77
Q

HIV drug therapy

HAART, NRTI, NNRTI, protease inhibitors, fusion inhibitors, entry inhibitors, integrate inhibitors

A

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

78
Q

Hairy leukoplakia

A

White lesions on the lateral aspect of tongue

Associated with hiv

79
Q

Sjögren’s syndrome and caplan’s syndrome

A

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)

80
Q

RA systemic complications

A
  • 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
81
Q

Swan neck deformity vs boutonnière deformity

A

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

82
Q

Lunar deviation

A

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

83
Q

What is something important to note about biologic response modifier drugs to treat arthritis

A

PPD rest given before administration and should be negative

Ex: etanercept (embrel), remicaide, humira

84
Q

Side effects of methotrexate

Used to treat RA

A

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)

85
Q

Clinical manifestations of rheumatoid arthritis

A

Early- joint stiffness, swelling, pain, fatigue, generalized weakness and morning stiffness, anorexia/weight loss, persistent low grade fever, joint involvement is bilateral & symmetric

86
Q

Monro-kellie doctrine of hypothesis

A

Brain tissue, blood and CSF occupy the skull, when one increases the other components must decrease to maintain equilibrium

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