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NP2 Test 3 Flashcards

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1
Q

Cranial Nerve 1
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Olfactory (have patient identify scents, occlude one nare)
  • Sense of Smell
  • Sensory
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2
Q

Cranial Nerve 2
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Optic (Pt tell time on clock/look at eye structures)
  • Vision in eyes
  • Sensory
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3
Q

Cranial Nerve 3
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Oculomotor (PERRLA)
  • Movement of eyes
  • Motor
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4
Q

Cranial Nerve 4
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Trochlear (Cardinal Gaze / Convergence)
  • Movement of eyes
  • Motor
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5
Q

Cranial Nerve 5
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Trigeminal (Touch Pt. with soft and sharp side of object, move jaw side to side)
  • Sensation in face / movement of jaw muscles
  • Both
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6
Q

Cranial Nerve 6
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Abducens (Cardinal field of gaze / lateral vision test)
  • Eye movement
  • Motor
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7
Q

Cranial Nerve 7
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Facial (smile, frown, puff cheeks, expressions)
  • Taste / movement of face for facial expressions
  • Both
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8
Q

Cranial Nerve 8
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Vestibulocochlear (Whisper test / Weber Rinne air conduction test)
  • Hearing
  • Sensory
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9
Q

Cranial Nerve 9
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Glossopharyngeal (Taste test/rise of palate and uvula when patient says “ahhh”)
  • taste / movement of pharynx
  • Both
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10
Q

Cranial Nerve 10
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Vagus (Pt swallow look @ pallets and uvula)
  • Pharynx sensation / movement of viscera organs (heart, lungs, intestines, etc)
  • Both
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11
Q

Cranial Nerve 11
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Accessory (Have pt. shrug shoulders)
  • Movement of neck muscles
  • Motor
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12
Q

Cranial Nerve 12
What is it?
What is it’s function?
Is it sensory or motor?

A
  • Hypoglossal (Have pt. stick tongue out and watch for drifting to one side)
  • Movement of tongue
  • Motor
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13
Q

What are the mnemonics to remember cranial nerves?

A
  • Oh Oh Oh To Touch And Feel Very Good Velvet, Ah Heaven! (Nerves)
  • Some Say Marry Money But My Brother Says Big Boobs Matter Most. (Function)
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14
Q

In a patient with an altered level of consciousness (ALOC), which assessments should the nurse perform?

A
  • Glasgow Coma Scale rapid neuro checks.
  • Vital Signs
  • Pupil size, limb movements, bladder, lung sounds, cardiac status
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15
Q

Why is it important to include an ALOC patient’s significant other and family members in the patients care?

A

If the patient is unresponsive it’s important to know their background and medical history.

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16
Q

A decrease of ___ or more on the Glasgow Coma Scale is significant. What must the nurse do?

A
  • 2

- Must report to the PHCP!

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17
Q

Why is any new abnormal flexion noteworthy for an ALOC patient on the GCS?

A

May be R/T intracranial pressure or worsening of neurological condition

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18
Q

On the Glasgow Coma Scale, what score indicates a client is comatose?

A

8 or less

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19
Q

On the Glasgow Coma Scale, what score indicates a client is totally unresponsive?

A

3

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20
Q

On the Glasgow Coma Scale, what score range is considered acceptable?

A

9-15 (15 is best)

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21
Q

What are some common causes of ALOC?

A

Neurological, toxic, or metabolic issue may cause ALOC.

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22
Q

What cranial nerve checks PERRLA?

A

Cranial nerve 3 (occulor motor nerve)

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23
Q

What is ‘pronator drift’ and what does it check for?

A
  • Checks for brain stem function.
  • Patient holds their arms out in front of them with their eyes closed, if one arm starts drifting, it could signal brain stem issue.
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24
Q

What is decorticate rigidity?

A

Extremities go towards the care of the body due to brainstem dysfunction.

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25
Q

What is decerebrate rigidity?

A

Extremities are distended and flexed outwards away from the body due to brainstem dysfunction.

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26
Q

What is the main concern for for ALOC patients?

A

Breathing is the main concern for ALOC patients. (can’t cough to clear secretions, can’t breathe, risk for aspiration, etc.)

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27
Q

What interventions should the nurse perform for ALOC patients?

A
  • Maintain respiratory function (suction, insert airway, etc)
  • nutrition/fluid support
  • monitor for changes in condition (document and report)
  • prevent immobility complications
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28
Q

What is the safest position for an ALOC patient to be in, in order to maintain resp. function?

A

Semi-Fowlers.

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29
Q

What is important to remember for ALOC patients in terms of nutritional and fluid support?

A

NPO until responsive and safe swallowing has been established.

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30
Q

Nurses should re position an ALOC pt every two hours to prevent what?

A

Skin breakdown (ALOC = high risk)

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31
Q

If a nurse is caring for an ALOC pt. with skin breakdown, she must do what in order to change the surface the patient is lying on?

A

Initiate an order to/from the physician.

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32
Q

Contractures happen quickly (~ 4 days) in an immobile ALOC patient, how should the nurse help prevent this?

A
  • Positioning patient in a non-bent or non-flexed position

- Perform passive ROM exercises on the patient.

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33
Q

What are some signs of changing condition in ALOC patients?

A

HR, Rise in BP, widening pulse pressure, temperature fluctuations, LOC changes, pupillary changes

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34
Q

Temperature changes in ALOC pts. are important because it can lead to _______?

A

Edema, which leads to IC pressure.

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35
Q

What is the definition of migraine?

A

Recurrent episodic pain in the head that may be accompanied with photophobia, phonophobia, N/V, movement of head makes S/S worse.

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36
Q

What is the cause of migraines?

A

No organic cause, etiology is unknown.

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37
Q

What are some common migraine triggers?

A

MSG, wine, aspartame, smells, foods with TYRAMINE in them (chocolate, cheese, caffeine), stress, hormones, fatigue.

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38
Q

Migraines are a ______, not a disease!

A

Symptom

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39
Q

If a patient experiences frequent migraines, they are also more at risk for _______ and _______.

A

Epilepsy and Stroke

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40
Q

Migraine with aura (Classic migraine)

A

Change in sensation that precipitates the migraine.

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41
Q

Migraine without aura (common migraine)

A

Most common, no aura.

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42
Q

Atypical Migraine

A

Migraine that lasts longer than 72 hours, may have a stroke with this.

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43
Q

What are the four stages of migraines and what occurs in each stage?

A
  1. Prodromal (before pain) - mood changes, cravings, neck stiffness, constipation.
  2. Aura - visual disturbances, neurological changes.
  3. Attack - PAIN, sensitive to light/sound/smells/touch, N/V, lightheaded.
  4. Postdromal - Confusion, weakness, dizziness, light/sound sensitivity, moodiness.
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44
Q

What is Dihydroergotamine (DHE?)

A
  • abortive migraine medicine used to stop the pain
  • do NOT give with Triptan drugs (causes coronary artery vasospasms if used together)
  • can give IM, IV, SubQ, intranasal
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45
Q

What is Sumatriptan? What are the side effects?

A
  • abortive migraines medicine used to stop the pain
  • flushing, tingling, hot are common side effects
  • do not use with MAOIs, SSRIs (may cause neuropathic malignant syndrome), DHE
  • Do not give to patients with HTN, heart disease, cerebrovascular disease.
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46
Q

What is the priority nursing management once a migraine occurs in a patient?

A

STOP the migraine! Pain management.

- Opioids, NSAIDs, Tylenol, Antiemetics

47
Q

What medications can help prevent migraines?

A
  • Beta Blockers (end in -lol) (vasoconstricting)
  • Calcium Channel Blockers (vasoconstricting)
  • Anticonvulsants
  • Tricyclic antidepressants
  • Botox injections
48
Q

What are the two types of seizures?

A
  • Primary: unknown etiology, no identifiable cause

- Secondary: results from underlying brain lesion or identifiable cause

49
Q

What a person experiences 2 or more primary seizures in their lifetime, they are considered to have ____________.

A

Epilepsy

50
Q

How long do seizures usually last? What time frame is considered a medical emergency?

A

Seizures last 30 seconds - 2 minutes.

5 minutes or longer is a medical emergency

51
Q

What are the three categories of seizures?

A
  • Generalized
  • Focal (partial)
  • Unclassified
52
Q

What is a generalized seizure?

A

Occurs in both hemispheres of the brain, the whole brain turns on at once. Pt is unconscious.

53
Q

Tonic Clonic (generalized seizure)

A
  • also called grand mal seizure.

- alterations between muscle contractions and jerking of all four extremities.

54
Q

Tonic (generalized seizure)

A
  • Increased muscle tone

- (tone = ton)

55
Q

Clonic (generalized seizure)

A
  • Muscle contractions and relaxations

- (C in clonic, C in contractions)

56
Q

Myoclonic (generalized seizure)

A
  • Muscle jerking in extremities

- Can be mistaken for clumsiness

57
Q

Atonic or Drop Attack (generalized seizure)

A

Sudden loss of muscle tone and consciousness.

58
Q

Absence or petit mal (generalized seizure)

A

Quick sudden loss of consciousness, staring spells.

59
Q

Which types of generalized seizures have a posictal period of confusion and sleepiness?

A

Tonic Clonic and Atonic seizures.

60
Q

What is a Focal Seizure?

A

A seizure that affects one hemisphere of the brain.

61
Q

What are the two types of focal seizures?

A
  • Focal Aware (simple partial): Pt is concious, autonomic changes, Aura
  • Focal Impaired Awareness (complex partial): Pt loses consciousness, confusion, aura may premeditate this.
  • Presentation depends on which hemisphere is affected.
62
Q

Right vs Left Hemispheres

A
  • Right: Visual/Spacial, Music, Face Recognition

- Left: Language, Math, Logic

63
Q

Causes of Seizures?

A

Primary: Idiopathic/Genetics
Secondary: Hypoxemia, Fever (quick increase in temp = seizure), Fluid imbalance, head injury, brain tumor, infection, toxins, allergens, metabolic condition.

64
Q

What information would a nurse want to gather about a patient regarding history of seizures?

A
  • Aura or no?
  • Length of seizure and description of seizure
  • Patient condition during seizure
  • Recovery period
65
Q

What are seizure precautions?

A
  • padded side rails up
  • suction and oxygen at bedside
  • IV access for emergency med administration
  • NPO, nothing in patients mouth except oral airway if there is seizure down time.
66
Q

What are some nursing seizure interventions?

A
  • protect pts head
  • turn patient on side to prevent aspiration
  • do not restrain pt.
  • suction as needed
  • ensure patent airway after seizure
  • oxygen as needed for after seizure
67
Q

What should patients who are taking antiepileptic drugs (AEDs)/anticonvulsant drugs for seizures know?

A
  • Frequent lab work is needed to check for therapeutic range
  • ## avoid citrus juice, it decreases absorption of AEDs (grapefruit juice can cause toxicity)
68
Q

What are two common AED/anticonvulsant medications?

A
  • Phenytoin (also known as Dilantin)

- Carbamazapine

69
Q

What is Phenytoin’s small therapeutic range?

A

10-20; patients on this need frequent lab work.

70
Q

Is a patient who was put on AEDs ever allowed to stop the medication?

A

No, even without seizures they must never be stopped for the rest of the patients life.

71
Q

AEDs can cause _______ and ___________ so the patient must get frequent CBC and live function tests done.

A

Leukopynia and liver damage

72
Q

The AED medication Phenytoin is contraindicated in patients who also take ___________ due to increased risk of bleeding.

A

Coumadin (AKA warfarin)

73
Q

What is status epilepticus?

A

Seizures >8 minutes long or clusters of seizures >30 minutes. MEDICAL EMERGENCY. STOP THE SEIZURE.

74
Q

What causes status epilepticus?

A
  • Most common cause is pt’s sudden stopping of AED medication.
  • infection, trauma, brain edema, drug/alcohol use.
75
Q

Seizures that last longer than 10 minutes can result in ___________.

A

Brain death

76
Q

What medicines are given during status epilepticus seizures?

A

Benzos (end in -pam)

  • Lorazepam (ativan) (IVP 4mg/2 min up to 8 mg)
  • Diazepam (valium) (IVP/IM 5-10mg q. 5-10min up to 30 mg)
  • Diazepam Rectal Gel
77
Q

When is Phenytoin (dilantin) or Fosphenytoin (cerebyx) given?

A

AFTER status epilepticus seizure is over. Fosphenytoin has less cardiac effects than phenytoin.

78
Q

What are some surgical interventions for patients with seizures?

A
  • Vagal Nerve Stimulator (avoid microwaves, short wave radios, ultrasound diathermy)
  • Corticectomty (remove area causing seizure in brain)
  • Partial Corpus Callosotomy (partially sever corpus callosum to lessen seizure signals)
79
Q

What are the three types of meningitis?

A
  • Bacterial (medical emergency, most deadly)
  • Fungal (AIDS patients susceptible)
  • Viral (most common)
80
Q

What clinical manifestation is specific to meningococcal meningitis?

A

Petechial Rash (Neisseria)

81
Q

A positive Brudzinski’s Sign may indicate a patient has meningitis. What is this sign?

A

Lifting of patients head causes pt’s knees to pull up in a crunch fashion (Has a Z in it, grants last name has a Z, grant does crunches)

82
Q

A positive Kernig’s Sign may indicate a patient has meningitis. What is this sign?

A

Lifting patients leg up causes pain in other areas. (Eg: back)

83
Q

What does the CSF of a patient with viral meningitis look like?

A
  • Clear Color

- No Culture

84
Q

What does the CSF of a patient with bacterial meningitis look like?

A
  • hazy cloudy color

- culture grows

85
Q

Meningitis can cause what complications?

A

Seizure
Shock
Increased ICP

86
Q

What is the best way to treat meningitis?

A

Vaccination for it!
ABX
Antivirals
Antifungals

87
Q

Which age group is most at risk for meningitis?

A

Ages 16-24 highest risk. (college ages)

88
Q

What are the four cardinal symptoms of Parkinson’s Disease?

A

T- Tremors
R- Rigidity
A- Akinesia
P- Postural Instability

89
Q

What are some common drugs that can cause drug induced Parkinson’s (DIP) when taken?

A 
Antipsychotics
GI motility (reglan)
Ca++ Channel Blockers
Lithium
SSRIs
90
Q

A decrease in which neurotransmitter is involved in Parkinson’s Disease?

A

Dopamine

91
Q

In which part of the brain is Dopamine produced in?

A

Substantia Nigra

92
Q

Which clinical manifestation is normally the first sign of Parkinson’s tremors in the general population?

A

Pill-Rolling; arm at rest but hand and thumb tremoring.

93
Q

By the time symptoms are present and noticeable about ____% of the dopamine has already been destroyed.

A

80%

94
Q

What are some S/S of parkinson’s disease?

A 
Tremors
Handwriting changes
Rigidity in extremities (cogwheeling/lead piping)
Drooling
Difficulty swallowing
Bad posture/gait
95
Q

Patients taking Parkinson drugs need to be monitored for drug toxicity and tolerance. Mild toxicity can look like what?

A

Anxiety
Confusion
Tachycardia

96
Q

Patients taking Parkinson drugs need to be monitored for drug toxicity and tolerance. Chronic toxicity can look like what?

A

Delirium
Hallucinations
Dyskinesia

97
Q

In patients with Parkinson’s Disease we want to increase the level of Dopamine, but dopamine can’t cross the BBB by itself so we have to give the patient ________, the precursor to dopamine which converts into dopamine once it reaches the brain.

A

Levodopa

98
Q

Why is carbidopa added to levodopa?

A

It helps increase availability and transport to the brain..

99
Q

What is the function of MAOI Type B in treating parkinsons?

A

Reduces the rate at which monoamine oxidase in the brain breaks down dopamine

100
Q

What function do COMTs (catechol O-methyltransferases) serve in treating Parkinson?

A

Prevents methyl groups from being transferred onto dopamine and disabling it.

101
Q

How do dopamine agonists work in treating parkinsons and when should they be used?

A

Mimic dopamine by stimulating dopamine receptors in brain. They are good for early on when the disease isn’t too severe,

102
Q

What classes of medications are used to primarily treat Parkinson’s Disease?

A

Dopaminergics (carbadopa-levodopa)
Dopamine Agonists
Monoamine Oxidase Type B Inhibitors (selegiline)
Catechol O-methyltransferases

103
Q

What is dementia?

A

loss of brain function that is CHRONIC and PROGRESSIVE

104
Q

What is the most common type of dementia?

A

Alzheimers Disease

105
Q

What are major risk factors for dementia?

A

Female
African American
Older Age (>65)

106
Q

What is the usual cause of death in patients with dementia?

A

Immobility.

107
Q

What neurotransmitter involved in Alzheimer’s Disease is decreased?

A

acetylcholine; low levels of acetylcholine leads to plaque build up in brain.

108
Q

What is the only definitive way to know if someone has alzheimer’s or not?

A

Autopsy after death.

109
Q

People which Alzheimer’s also have abnormal protein in their brain often known as _______

A

beta-amyloids

110
Q

What are the three stages of dementia?

A

Early - mild memory loss, difficulty concentrating, may hide symptoms from others
Middle - longest stage, personality changes, moodniess, increased memory loss, increased confusion, wandering, ADL difficulty
Late - severe memory loss, increased risk for everything, maybe can’t talk/walk/eat.

111
Q

What are the four alterations in communication that dementia patients may suffer? (Four A’s)

A

Apraxia - inablility to use words appropriately
Aphasia - inability to speak or understand
Anomia - inability to find the name of the word (nomenclature)
Agnosia - loss of sensory perception (AKA smell, agNOSia)

112
Q

What is ‘sundowning’ during the middle stage of dementia?

A

Increased confusion and agitation at night time.

113
Q

What are some ways to promote cognitive functioning in patients with dementia?

A

Intellectual stimulation, memory training, promote communication, reduce distractions, reminiscent remember therapy (talk about past memories and relate them to present)

Nursing Process 2 (2 decks)

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