Nursing 2MM3 Exam Review Flashcards
What are modifiable risk factors?
Those that can be potentially altered through lifestyle change and medical treatment
- hypertension
- diabetes
- high cholesterol
- smoking
What are non-modifiable risk factors?
Age, gender, race, low birth rate
What is an ischemic stroke?
results from inadequate blood flow to the brain from partial or complete blockage of artery
What is a transient ischemic stroke?
temporary episode of neurological dysfunction, symptoms last less than 1 hour
What is a thrombotic stroke?
Occurs when a clot forms in a diseased and narrowed BV in the brain
- most common
- sudden onset
- usually remains conscious in first 24 hrs
What is an embolic stroke?
occurs when an embolus lodges and blocks a cerebral artery resulting in infarction
- remains conscious
- sudden onset
What is a hemorrhagic stroke?
result from bleeding in the brain tissue or in the subarachnoid space
What is a intracerebral stroke?
bleeding in the brain caused by a rupture of a vessel
- occurs during activity
- sudden onset
- decreased LOC
What is a subarachnoid stroke?
intracranial bleeding into the CSF filled space
- silent killer
What are side effects of left sided stroke?
paralyzed right side, expressive aphasia, receptive aphasia, amnesic aphasia, global aphasia, dysphagia, slow and cautious, memory deficits
What is expressive aphasia?
AKA: Broca’s aphasia
- cannot produce language, spoken or written
- can understand speech
- singing can be used as a tool
What is receptive aphasia?
inability to understand written or spoken language
What is global aphasia?
Both receptive and expressive
What are side effects of right sided stroke?
Paralyzed left side, spacial-perceptual, impulsive and quick moving, memory deficits
What is a MRI used for?
used to determine the extent of injury, greater specificity in determining location
What is a CT scan used for?
fast imaging, indicates size and location of lesion, helps differentiate between the type of stroke
What is delirium?
state of acute mental confusion
What is delirium characterized by?
acute onset, fluctuating course, altered LOC
What are predisposing factors?
present at the time of admission, demographic, cognitive status, functional status, coexisting conditions
What are precipitating factors?
noxious insults related to hospitalization, surgery, drugs, incurrent illness
What is hypoactive delirium?
decreased alertness, decreased psychomotor activity
What is hyperactive delirium?
Agitation, restlessness and hallucinations
What is mixed delirium?
alternating periods of hyperactive and hypoactive
What is dementia?
impaired memory, slow gradual decline, chronic, decreased orientation, decreased ability to perform ADL’s
What is vascular dementia?
cause by stroke or chronically damaged/narrowed brain blood vessels
What are signs and symptoms of vascular dementia?
difficulty concentrating and analyzing situations, unsteady gait, restlessness, agitation, incontinence
What are risk factors for vascular dementia?
aging, increased BP, atherosclerosis, diabetes
What is Parkinson’s dementia?
a progressive neurodegenerative disease of the CNS
What are signs and symptoms of Parkinson’s dementia?
dysphagia, difficulty concentrating, confusion
What is the progression of Parkinson’s dementia?
gradual onset, ongoing progression
What is Alzheimer’s disease?
abnormal protein deposits form plaques and tangles in the brain (connections b/w cells die off)
What are signs and symptoms of Alzheimer’s disease?
memory loss, disorientation, reduced cognition, decline in social skills
What are risk factors for Alzheimer’s disease?
older population, genetic, hospitalization, medical conditions
What are treatments for Alzheimer’s disease?
creating a safe and supportive environment, cholinesterase inhibitors
What is lewy body dementia?
protein deposits in nerve cells, accumulation of Lewy bodies results from the loss of neutrons that create ACTH and dopamine
What are signs and symptoms of Lewy body dementia?
cognitive fluctuations, hallucinations, motor disturbances
What are risk factors for Lewy body dementia?
60+, male, family history
What is fronto-temporal dementia?
degeneration of the frontal, temporal, or both sides (tau protein)
What are signs and symptoms of fronto-temporal dementia?
behavioural: loss of inhibitions, depression, compulsivity, loss of empathy
language: aphasia, loss of semantics
What is the progression of fronto-temporal dementia?
gradual decline, stepwise, rare, more common younger
What is Huntington’s dementia?
A progressive brain disorder caused by a single defective gene on chromosome 4
What are signs and symptoms of Huntington’s dementia?
involuntary jerking, slow abnormal eye movement, impaired gait, difficulty with speech and swallowing
What are cognitive changes of Huntington’s dementia?
disorganized thinking, behavioural/emotional instability, lack of awareness
What are behavioural changes of Huntington’s dementia?
depression, irritability, social withdrawal, insomnia, fatigue
What is prediabetes?
blood sugars that are higher than normal, can turn into type 2
What are risk factors for prediabetes?
high BP, high cholesterol, high BMI, sleep apnea, psychiatric disorders
What is gestational diabetes?
occurs during the 2nd or 3rd trimester of pregnancy
What is metabolic syndrome?
cluster of metabolic disorders, abdominal obesity, increased TG levels, decreased HDL levels, hypertension, increased glucose levels, insulin resistance
What is type 2 diabetes?
insulin resistance or dysfunctional secretions
What are risk factors for type 2 diabetes?
40+, family history, history of prediabetes, heart disease, hypertension, high cholesterol, overweight, sleep apnea
What are signs and symptoms of type 2 diabetes?
non specific manifestations, fatigue, weight gain, tingling/numbness, prolonged wound healing
What is type 1 diabetes?
the pancreas does not produce any insulin, rapid onset, acute manifestations
What are signs and symptoms of type 1 diabetes?
polyuria, polydipsia, polyphasic, weight loss, weakness, fatigue
What is nephropathy?
microvascular complications associated with damage to the SBV’s that supply the glomeruli of the kidney
What is neuropathy?
nerve damage that occurs because of the metabolic derangements associated with diabetes
What is retinopathy?
microvascular damage to the blood vessels of the retina
What is hypoglycaemia?
extremely low blood glucose levels
What are risk factors for hypoglycaemia?
alcohol intake without food, loss of weight without change in dose, taking too much meds/insulin, pregnancy
What are symptoms of hypoglycaemia?
cold/clammy skin, headache, hunger, nervousness, tachycardia, confusion, nausea, numbness/tingling
What is hyperglycaemia?
high blood glucose levels
what are risk factors for hyperglycaemia?
corticosteroids, emotional/physical stress, illness, infection, lack insulin
What are symptoms of hyperglycaemia?
abdominal cramps, blurred vision, elevated BG, headache, increased urination, weakness, fatigue
What are symptoms of hyperglycaemia?
abdominal cramps, blurred vision, elevated BG, headache, increased urination, weakness, fatigue
What is environmental data?
home characteristics, community characteristics, access to healthcare
What is the Friedman family assessment model?
identifying data, developmental stage and history, family structure, family function, family coping
What is the Calgary family assessment model?
developmental stages, structural, developmental, functional
What is ethnicity?
a family’s cultural, historical, linguistic and ethnic origin
What is race?
influences individual members and group identification
What is social class?
shaped by education, income and occupation
What is religion and spirituality?
can influence their ability to cope with or manage an illness or health concern
What is environment?
the larger community, neighbourhood and home contexts
What is gender?
a set of beliefs or expectations of masculine and feminine behaviours and experiences
What is rank order?
order of children by age and gender
What are subsystems?
smaller groups of relationships within a family
What is a functional assessment?
how family members interact and behave towards each other
- instrumental functioning
- expressive functioning
What is instrumental functioning?
the normal activities of daily living
What is expressive functioning?
the ways in which people communicate
- emotional communication
- verbal communication
- nonverbal communication
- circular communication
- problem solving
- roles
What is developmental assessment?
nteractions between an individuals development and the phase of the family developmental lifestyle
1) family life stages
2) tasks
3) attachments
What is the McGill/Developmental Model?
family as a subsystem, health as the focus of worth, learning the process through which the health behaviours are acquired
What is a randomized control trial used for?
effectiveness of a prevention or treatment/therapy/intervention
What is a randomized control trial?
strongest design, people randomly selected to receive the intervention or not to
What are pros of randomized control trial?
random selection and longitudinal
What are cons of randomized control trial?
cost, long period follow up, generalizability
What are cohort analytic studies used for?
effectiveness of a prevention, treatment, intervention
What is a cohort analytic study?
longitudinal, prospective study
- 2 groups people select control or experimental
- NO randomization
- group differences may be due to factors that were there prior to intervention
What are cons of cohort analytic study?
increased bias, expensive
Cohort analytic study
Eligible participants –> non random allocation
- -> a) school based –> i) outcome ii) no outcome
- -> b) diet exercise –> i) outcome ii) no outcome
What is investigator triangulation?
more than 1 data collector
What is theory triangulation?
findings are examined in relation to existing theories
What is member checking?
come up with an idea and go back to ask the participant
What is PICO?
Population, intervention, comparison, outcome
What is a case control study used for?
exposure is related to an outcome
What is a case-control study?
looks at 2 groups of people, those that were exposed to the intervention and those that weren’t (look back in time)
What are pros of case-control studies?
allows assessment of unreachable populations, control group included
What are the negative of case-control studies?
hard to get control group that matched perfectly
What is the mechanism of case-control studies?
Eligible participants
- -> outcome –> i) exposure ii) no exposure
- -> no outcome –> i) exposure ii) no exposure
What is a cohort study used for?
What is the likelihood that a person will experience or develop the outcome if they are exposed to a disease
What is a cohort study?
participants are followed over time, ensure the disease preceded outcome
What is the mechanism of a cohort study?
eligible participants with exposure
- -> outcome
- -> no outcome
What is a phenomenological approach?
the lived experience of individuals
What is grounded theory?
the process that shapes behaviour and interaction
What is ethnographic study?
how cultural knowledge, norms, values influence one’s life experience within social context of a culture or subculture
What is homogenous sampling?
select participants who have similar narratives of a phenomenon
What is heterogenous sampling?
select participants who can provide different narratives of a phenomenon
What is snowball sampling?
used when no sampling frame exists
What is theoretical sampling?
associated with grounded theory, aim to seek data that challenge emerging ideas
What is the effect of smoking on surgery?
smokers are at an increased risk for post op complications
- increased mucous thickness
- greater difficulty clearing airways
What is the effect of alcohol/substance abuse on surgery?
predispose the patient to adverse reactions of anesthetic, cross-tolerant, withdrawal
What is the effect of obesity on surgery?
reduce respiratory and cardiac function, increased risk of embolus, pneumonia, poor wound healing, dehiscence
What is the effect of immunocompetence on surgery?
excess thinning of skin, destruction of collagen, impaired vascularization, infection, poor wound healing
What is the effect of malnourishment on surgery?
poor tolerance of anesthesia, delayed blood clotting mechanism, infection, poor wound healing
What is the effect of young age in surgery?
less BV, dehydration, over hydration, airway management, temperature management
What are respiratory complications of surgery?
airway obstruction, hypoxemia, hypoventilation, atelectasis (collapsed lung)
What are cardiovascular complications of surgery?
hypotension, hypertension, dysrhythmia, fluid retention, DVT, syncope
What are the neurological complications of surgery?
delirium, delayed awakening
What are the GI/GU complications of surgery?
nausea and vomitng, post operative ileus, paralytic ileus, low urine output, urinary retention
What are integument complications of surgery?
surgical site infections
What are psychological complications of surgery?
anxiety, depression, confusion, delirium, disturbed sleep pattern, body image
What is the mechanism of biguanides?
enhance insulin sensitivity in the tissues and improve glucose transport into the cells
- doesn’t promote weight gain
What is the mechanism a-glucosidase inhibitors?
slow down the absorption of carbs in the small intestine
- not effective against hyperglycaemia
what is the mechanism DPP-4 inhibitors?
enhance incretin pathways, stimulates the release of pancreatic beta cells
What is the mechanism of SGLT inhibitors?
block the reabsorption of glucose by kidney, increasing glucose excretion and decreasing blood glucose levels
- enhances urinary glucose excretion
What the mechanism of insulin secretagogues?
increases beta cell insulin production from the pancreas
- promotes weight gain
- hypoglycaemia
What is the mechanism meglitinides?
stimulate a rapid and short lived release of insulin from the pancreas
- more rapidly absorbed and eliminated
What is the mechanism of thiazolidediones?
improve insulin sensitivity transport and utilization
- increased HDL and BP
What causes motor dysfunction in stroke patients?
symptoms are caused by destruction of motor neurons in the pyramidal tract
What is the outcome of elimination function in stroke patients?
prognosis of only one hemisphere affected is good because there is partial sensation of bladder filling and voluntary urination, constipation is common
What are warning signs of a stroke?
face drooping, arm weakness, speech difficulty
What is the most important point in a patients history?
time of onset
What is the time frame in which stroke will be assessed, acute health needs adressed, undergo diagnostic studies and receive thrombolytic therapy
4.5 ours from onset of symptoms
What does acute care begin with?
airway
breathing
circulation
What is the number of patients that worsen in the first 24-48 hours?
25%
What always increases after stroke and what meds are given?
bp always increases; give antihypertensive
T/F: many acute interventions are continued into rest of care
true
Physical therapy focus on
- mobility
- progressive ambulation
- transfer techniques
- equipment needed
Occupational therapy focuses on
- retraining skills of daily living
- cognitive and perceptual training
Speech therapy focuses on
- speech
- communication
- verbal and eating abilities
T/F: risk of aspiration pneumonia is low due to impaired consciousness and dysphagia
- false; its high
T/F: Enteral tube feedings also place the patient at risk for aspiration pneumonia
true
T/F: only certain patients should be screened for swallowing ability and kept on NPO until they know
false: all patients
What kind of airway is used to prevent the tongue from falling back and obstructing airway
oropharyngeal
If a artificial airway is needed what may need to occur?
tracheostomy
When should oral care be preformed when patients are on vent to prevent occurrence of vent assisted pneumonia
every 2 hours
What scale is used to evaluate and document neurologic status in acute stroke?
NIH stroke scale
What does NIHH measure?
- severity
- predicts short and long term outcomes
Goals for cardiovascular system are
- maintaining homeostasis
Why is hypertension sometimes seen after a stroke?
to increase cerebral blood flow
What is important to monitor for before ambulating patient?
orthostatic hypotension
After a stroke a patient is at risk for
venous thrombo embolism: not moving around much
Most effect prevention of VTE is
mobility
How should u position the joints ?
higher than the joint closer to it to prevent edema
T/F: skin is highly susceptible to breakdown after a stroke; compounded by
- true; lack of mobility, circulation and sensation
- age, poor nutrition, edema, dehydration and incontinence
What is the most common bowel problem for patients after a stroke?
constipation
What is used to prevent or treat constipation?
- stool softeners (laxatives, suppositories)
T/F: remove indwelling catheter as soon as possible to prevent infection
true
Bladder retraining:
- adequate fluid intake (7am-7pm)
- observe for restlessness (pee)
- scheduled toileting
- bladder distention assessment
Patients with left or right side stroke or at higher risk
right; mobility difficulties
In wha time span should the nutritional needs be met by someone who has had a stroke
- 72 hours
What position and how long should the patient be in it after feeding
high fowlers; 30 min
T/F: pureed foods and thin liquids are the best choice
false; to bland and smooth; can choke
T/F: milk products should be avoided as they increase viscosity of mucous and salivation
true
How is the effectiveness of dietary programs evaluated?
- maintenance of weight
- adequate hydration
- patient satisfaction
4 ways to check for swallowing safety
- sit patient at 90 degree angle
- assist patients head forward
- assist patient to remain sitting for 30 min
- ensure no food pocketing
Delirium risk factors
- older than 65 or 70
- alcohol use
- depression
- extensive surgery
- hip fracture
- previous delirium
- severe illness
agnosia
inability to recognize object by sight, touch or hearing
apraxia
inability to carry out learned sequential movements by command
t/f: elimination issues are temporary
true
anomic apasia
least severe; difficulty naming things
Dysarthia:
issue with muscle movement of speech
2/3 strokes occur in people above what age?
65 years
T/F: strokes are more common in men
true
What is the single most important risk factor for stroke?
hypertension
Diabetes increases the chance of getting a stroke by how many times?
4-5x higher
What does the severity of function loss depend on?
- location
- extent of brain involved
T/F: stroke is the third most common cause of death in Canada
true
Who gets strokes more? men or women
men
Who is more likely to die from a stroke?
women
t/f: those of colour are more likely to get a stroke
true
What arteries supply the brain?
- internal carotid
- vertebral
When does cell death occur?
after 5 min
when do thrombotic strokes occur?
- during sleep or after sleep
How do signs and symptoms of thrombotic strokes develop?
slowly
What is the most common stroke? 60%
thrombotic
2/3 of thrombotic strokes are associated with
- diabetes and hypertension
what are the two subtypes of hemorrhagic strokes?
- intracerebral: ruptured vessel
- subarachnoid: intrancranial bleeding into CSF
When do intracerebral strokes occur? Sudden or gradual onset of symptoms?
with activity; sudden onset with fast progression
Possible causes of subarachnoid strokes are
- drugs
- trauma
t/f: ischemic and hemorrhagic symptoms are the same
true
What would a stroke in the middle cerebral artery lead to?
greater weakness in upper extremities
Aphasia
total loss of comprehension and use of language
dysphagia
inability to communicate
t/f: if stroke affects one side of your brain it usually doesnt interfere with bladder problems
true
most important tests
- MRI
- non contrast CT
Which kind of infections are stroke patients particularly vulnerable to?
respiratory
t/f: patients with left sided stroke are commonly faster in organization and performance
false; slower
homonymous hemianopsia
blindness in the same half of each visual field
diplopia
double vision
ptosis
drooping eyelid
Nutrition: patients with severe impairment may require
- enteral: directly into stomach
- parenteral: into vein
How to assess swallowing
- elevate bed and presume with crushed ice or ice water to swallow
Wound Dehiscence
separation and disruption of previously joined wound edges; preceded by sudden discharge
Wound Evisceration
visceral organs protrude through wound opening
t/f: Surgical wound dressings are left dry and untouched for minimum 48 h postop
true
first sense to return in unconscious patients is
Hearing
emergence delirium
Occasionally patients will wake up agitated; a condition in which patients may be disoriented to place, time, and person.
- The goal of PACU care
is to identify actual and potential patient problems that may occur as a result of anaesthetic administration and surgical intervention
delirium tremens
post op reaction characterized by restlessness insomnia nightmares, tachycardia, apprehension, confusion, disorientation, irritability, hallucinations due to alcohol withdrawal
Three phases of PACU
- right after surgery; intense monitoring and ECG
- Ambulatory surgery patients; prepare for transfer home etc
- prepare patient for self care
Three phases of PACU
- right after surgery; intense monitoring and ECG
- Ambulatory surgery patients; prepare for transfer home etc
- prepare patient for self care
One side neglect is common in left or right stroke?
- right; forget to shave or dress one side
