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Exam 1 (Spring) > Neuromuscular / Sensory > Flashcards

Neuromuscular / Sensory Flashcards

1
Q

Spinal shock

A 
Flaccid paralysis 
Vasodilation 
Hypotension 
Bradycardia 
Increased venous capacity 
Hypothermia 
All reflexes below level of injury are lost 
Can have urinary and fecal retention
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2
Q

Complications following spinal cord injury

A 
Infections 
DVT 
Orthostatic hypotension 
Skin breakdown 
Renal complications
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3
Q

Autonomic dysreflexia (hyperreflexia)

A 
Increased reflex actions 
Severe bradycardia (low as 30/bpm)
Hypertension (systolic high as 300/mmHg)
Severe HA
**Most commonly caused from distended bladder & severely constipated**
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4
Q

Nursing management of SCI’s

A

Ensure patent airway
Maintain cardiovascular function
Move by log-rolling technique; use turning frames
Provide good skin care
Emotional support
Ensure adequate nutrition
Reduce aggravating factors that cause spasticity
Bladder and bowel training
Client and family education to cope with detailed care at home

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5
Q

MS S&S

A 
Muscle weakness
Tingling sensations 
Numbness
Visual problems/nystagmus/patchy blindness 
Urinary incontinence 
Fatigue 
Weakness
Spasticity of muscles 
Ataxia 
Sexual dysfunction 
Dysphagia; swallowing difficulties
Vertigo 
Cognitive impairment
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6
Q

NI’s for MS patients

A 
Well balanced diet 
High fiber 
Adequate fluids 
Good skin care
Regular exercise 
Daily rest periods 
Avoid hot baths and temperature extremes
Reduce stress
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7
Q

Immune Modulators

A 
Betaseron (interferon beta-1b) 
Avonex (interferon beta-1a) 
Adrenocorticotropic hormone (ACTH)
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8
Q

Corticosteroids

A

Prednisone or Decadron

Azathioprine (Imuran)

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9
Q

Immunosuppressive drugs

A

Cyclophosphamide (Cytoxan)
Valium, Baclofen
Pro-banthine: urecholine
Bactrim, Septra, and Macrodantin

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10
Q

Myasthenia Gravis

A

“grave muscle weakness*
AUTOIMMUNE disease of the NEUROMUSCULAR JUNCTION
Unpredictable
Nerve impulses fail to pass at the myoneural junction
Causes muscular weakness

10-65 years of age

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11
Q

Myasthenia Gravis S&S

A 
Ptosis - drooping eyelid 
Diplopia 
Skeletal weakness; ataxia 
Dysarthria; dysphagia 
Weak vocal cords 
Voice sounds nasally 
Muscle weakness
Bowel and bladder incontinence
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12
Q

NI’s for Myasthenia Gravis

A 
Monitor for UR infections 
Suctioning PRN
Change daily patterns for activity 
Physical therapy ROM 
Must take medication at same time everyday
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13
Q

Anticholinesterase drugs

A

Prositigmin

Mestinon

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14
Q

Complications of Myasthenia Gravis

A 
Aspiration 
Respiratory infection and failure 
Myasthenic crisis 
Cholinergic crisis 
SLUDGE 
-Salivating 
-Lacrimation (tearing) 
-Urination 
-Diarrhea 
-GI cramping 
-Emesis
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15
Q

Amyotrophic Lateral Sclerosis (ALS)

A

“Lou Gherig’s Disease”
“Steven Hawkings”
Rare progressive DEGENERATIVE NEUROLOGICAL disease
Death results usually in 2-6 years
Motor neurons in brain stem and spinal cord gradually degenerate
Electrical and chemical messages originating in brain do not reach muscles to activate them
No cure

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16
Q

Clinical Manifestations of ALS

A 
Upper extremity weakness 
Dysarthria 
Dysphagia 
Muscle wasting & fasciculations 
Death from respiratory infection secondary to compromised respiratory function 
*Person usually remains mentally alert*
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17
Q

Diagnostic Tests for ALS

A

Clinical symptoms
CSF analysis
EEG
NCV (nerve conduction velocity)

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18
Q

Fasciculations

A

Involuntary muscle twitching

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19
Q

NI’s for ALS

A

Baclofen & Valium
Rilutek
Multidisciplinary ALS teams; emotional support

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20
Q

Huntington’s DIsease

A

Overactivity of dopamine pathways
Genetically transmitted
Onset 30-50 years old

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21
Q

Clinical Manifestations of Huntington’s Disease

A

Abnormal or excessive involuntary movements ((chorea))
Ataxia to immobility
Gait deteriorates
Mental functions deteriorates
Death usually 10-30 years after onset of symptoms

22
Q

NI’s of Huntington’s Disease

A 
No cure; palliative 
Antipsychotics
Antidepressants (Xenazine [tetrabenazine])
Safe environment 
Emotional support 
High calorie diet (4,000-5,000)
23
Q

Guillain-Barre Syndrome

A

Inflammation and demyelination of the PNS

Possibly viral or autoimmune reaction

24
Q

Clinical Manifestations of Guillain-Barre Syndrome

A

Progressive symptoms
Ascending paralysis - usually starts in lower extremities and moves upward
May stop at any point
Muscle weakness
Paralysis
Tingling
Numbness
Respiratory failure if intercostal muscles are affected
May have difficulty swallowing, breathing, and speaking
Fluctuating BP

25
Q

Cause of Guillain-Barre Syndrome

A

Unknown
May be viral or autoimmune
In 1980’s people developed GB after swine flu vaccine

26
Q

Tests for Guillain-Barre Syndrome

A

History of symptoms and recent infections
CT scan
Lumbar puncture - increase in protein is a red flag
Nerve conduction velocity study

27
Q

NI’s for Guillain-Barre Syndrome

A 
Plasmapheresis 
Immunoglobulin therapy 
Anticoagulants 
Analgesics 
Mechanical ventilation 
G tube 
Meticulous skin care 
ROM exercises
28
Q

Encephalitis

A 
Inflammation of brain tissue 
Similar to meningitis 
Caused by: viruses, bacteria, spirochetes, fungi, protozoa 
Serious sometimes fatal 
Mortality rate: 5-20%
29
Q

Encephalitis caused by complications of:

A 
Measles
Chicken pox 
Mumps 
Outdoor job or hobby 
Associated with certain season (warmer) and certain geographic areas
30
Q

Encephalitis MOT

A

Ticks

Mosquitoes

31
Q

Clinical Manifestations of Encephalitis

A 
Flu-like 
Maliase 
Fever 
HA 
Dizziness
Nuchal rigidity 
N/V
Ataxia 
Tremors 
Seizures 
Coma and maybe death 
*Major sign in infant: bulging of the soft spot (fontanels)*
32
Q

Tests for Encephalitis

A 
Symptoms 
ID'ed the virus 
Lab tests: 
   Serologic test
   CSF cultures (spinal tap) 
   MRI 
   PET
33
Q

NI’s for Encephalitis

A 
Hospitalization for strict observation 
Administering meds 
Supportive care 
Control fever 
Ensure adequate hydration and nutrition 
Monitor VS
34
Q

Treatment for Encephalitis

A

Diuretics (Mannitol)

Corticosteroids (dexamethasone/decadron)

35
Q

Treatment for Encephalitis caused by Herpes

A

Acyclovir (Zovira)

Vidarabine (Vira-A)

36
Q

Poliomyelitis

A

“Polio”
Acute viral infection involving the GI tract and occasionally the CNS

Declined rapidly after licensure of inactivated polio vaccine 1955 and live polio vaccine in 1960

Most common in infants and children; young adults and older adults can contract it too

37
Q

MOT of Polio

A

Fecal-oral transmission

38
Q

Symptoms of Polio

A 
Asymptomatic (most infectious) to symptomatic 
Mild Symptoms: 
   Sore throat 
   HA
   Malaise 
   Upset stomach 
   Low-grade fever 
May include acute flaccid paralysis of a single limb to quadriplegia (affects fewer than 1%) 
Respiratory failure 
Death
39
Q

NI’s for Polio

A

NO medication treatment
Isolate
Bed rest
Pain-relievers
May need assistance breathing - supplemental O2 or ventilator
Provide proper positioning and ROM exercises

40
Q

Prevention of Polio

A

Vaccine
Limiting exposure/contact with infected secretions
Hand washing

41
Q

Post-Polio Syndrome (PPS)

A

Development of new symptoms in persons who have had polio

After period of stable physical symptomology of at least 15 years

42
Q

Cardinal Symptoms of PPS

A

Weakness in previously affected or unaffected muscles

Fatigue with general reduction in stamina and pain in either joints or muscles or both

43
Q

Less common symptoms of PPS

A

Muscle atrophy
Respiratory dysfunction
Swallowing dysfunction
Cold intolerance

44
Q

Management of PPS

A 
Facilitating appropriate levels of exercise with concurrent energy conservation 
Education 
Lifestyle changes 
Tailored exercise programs 
    Muscle strength & endurance 
Psychological 
    Depression (monitor for) 
    Life satisfaction
45
Q

Spinal cord injury to C1-C3

A

Usually fatal

No independent respiratory function

46
Q

Spinal cord injury to C4

A

Quadriplegic; paralyzed neck down

May be able to breathe independently

47
Q

SCI to C5-C6

A

Quadriplegic with some arm and shoulder movement

48
Q

SCI to C7-C8

A

Quadriplegic with some arm and hand movement

49
Q

SCI to T1-T6

A

Paraplegic; some trunk movement, legs paralyzed

50
Q

SCI to T7-T12

A

Paraplegic; good upper back and abdominal strength, May function well in wheelchair

51
Q

SCI to L1-L4

A

Paraplegic; may learn to walk with crutches or braces

Exam 1 (Spring) (3 decks)

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