Pn2 Final Cp Flashcards
o Parkinson’s Disease
Cause:
degeneration of substantia nigra, resulting in too little dopamine and too much acetylcholine.
Parkinson’s
s/s:
Parkinson’s s/s:
Tremor, muscle rigidity, slow/shuffling gait, bradykinesia (slow movement), masklike expression, drooling, difficulty swallowing.
Parkinson’s Nursing care:
Monitor swallowing food intake,
thicken food,
sit patient upright to eat,
have suction equipment available.
Encourage ROM and exercise,
assist with ADL’s.
Parkinson’s disease Meds:
Levodopa/carbidopa (increases dopamine levels),
benztropine (decreases acetylcholine levels)
Non-reversible dementia, resulting in memory loss problems with judgement and changes in personality.
o Alzheimer’s dementia
Stages of Alzheimer’s/dementia
Stage 1-7
Stage1: no impairment
Stage2: Forgetfulness, no memory issues
Stage3: Mild cognitive deficits, short term memory loss noticeable to family members
Stage4: Personality changes, obvious memory loss
Stage5: Assistance with ADL’s necessary
Stage6: Incontinence (fecal, urinary), wandering
Stage7: Impaired swallowing, ataxia, no ability to speak.
Nursing care:
For Alzheimer’s/ dementia
Nursing care: Maintain structured environment. Provide short directions, repetition. Avoid overstimulation. Use single-day calendar. Provide frequent reorientation. Maintain routine toileting schedule.
Alzheimer’s dementia Home Safety:
REMOVE SCATTER RUGS.
Install door locks, good lighting (particularly on stairs)
Mark step edges with colored tape, remove clutter.
Alzheimer’s dementia Meds:
DONEPEZIL (prevents breakdown of Ach, improves ability to do ADLs)
other meds to manage symptoms:(antipsychotics, antidepressants, anti-anxiety meds)
S/s: PHOTOPHOBIA, NAUSEA/VOMITING, UNILATERAL PAIN (USUALLY BEHIND ONE EYE OR EAR).
Can happen with or with out aura (visual disturbances, numbness/tingling)
Pain persists for 4-72 hours.
o Migraines
Migraine Nursing care:
And meds:
provide cool, dark, quiet environment.
Teach patient to avoid triggering foods, reduce stress levels.
Meds: NSAIDs (mild migraine), antiemetics (for n/v), sumatriptan or ergotamine for more severe migraines.
Migraine Risk factors:
Allergies, bright lights, fatigue, stress, anxiety, menstrual cycles, certain foods (MSG, tyramine, nitrates).
Inflammation of meninges (membranes around brain and spinal cord)
o Meningitis
s/s of meningitis:
s/s of meningitis: headache, nuchal (neck) rigidity, photophobia, nausea, vomiting, positive KERNIGs and BRUDZINKIs signs (look up), fever, altered LOC, tachycardia, and seizures.
Difference between viral and bacterial meningitis
Viral type is most common and can resolve with out treatment.
Bacterial type of very contagious and deadly with a high mortality rate.
Dx for meningitis?
Lumbar puncture- to obtain CSF to dx meningitis. (Fluid taken from spinal canal for analysis)
Can also diagnose multiple sclerosis, syphilis, meningitis, infection in CSF.
Prevention for meningitis:
Immunizations help prevent bacterial meningitis.
(HIB), which is given to infants at 2 months?
MCV4 vaccine is given to students living in dorms.
Meningitis dx Procedure: instructions for pt
Before-
During-
After-
Before- have patient void,
During- position the patient in cannon ball position on their side, or have patient stretch over table while sitting.
Post-procedure- Patients should lay flat afterwards for several hours.
If the dura puncture site does not heal, CSF may leak, resulting in headache (administer pain meds and encourage increased fluid intake) Epidural blood patch can be used to seal off the hole.
CFS- spinal fluid will appear how with bacterial or viral? And elevated labs?
cloudy with bacterial meningitis as well as have decreased glucose content.
Viral type will have clear VSF.
Both- will have elevated protein and WBC’s.
Nursing care for meningitis:
Type of precautions, where to bring/place patient, what to avoid , precautions?
Nursing care:
Droplet precautions for 24 hours until antibiotics are administered.
-provide a quiet room, low light, HOB 30 degrees, monitor for increased ICP, tell pt to avoid coughing/sneezing to decrease ICP, and implement seizure precautions.
Uncontrolled electrical discharge of neurons in brain.
Seizures
Seizure that May be preceded by aura.
3 Phases:
Tonic episode:
Clonic Episode:
Postictal phase:
Tonic Clonic
3 Phases:
Tonic episode: stiffening of muscles, loss of consciousness.
Clonic Episode: 1-2 minute of rhythmic jerking of extremities
Postictal phase: confusion, sleepiness
chronic seizures (2 or more)
Epilepsy
Risk factors for epilepsy:
Triggering factors:
Risks- fever, cerebral edema, infection, toxin exposure, brain tumor, hypoxia, alacohol/drug withdrawl, fluid or electrolyte imbalances.
Triggers- Stress, fatigue, caffeine, flashing lights
Type of seizure-Loss of consciousness for a few seconds for a few seconds.
Key features: blank staring, eye fluttering, lip smacking, picking at clothes.
Absence
Type of seizure:
brief stiffening of extremities
Myoclonic
Type of seizure : loss of muscle tone, results in FALLING.
Atonic
Type of seizure:
Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes.
Status epilepticus:
Diagnosis for seizure
Diagnosis: EEG to identify origin of seizure.
** Nursing care:
During seizure:
Post seizure:
Meds:
** Nursing care:
During seizure: TURN PATIENT TO THE SIDE, loosen restrictive clothing, DO NOT INSERT AIRWAY OR RESTRAIN PATIENT, document onset/duration of seizure.
Post seizure: check vital signs, neurological checks, reorient patient, seizure precautions, determine possible trigger.
Meds: anti-seizure meds such as phenytoin.
Surgeries for seizures:
Vagal nerve stimulator, craniotomy to remove brain tissue causing seizures.
What is the coma scale used
After seizure to determine Level of
Consciousness
3-8:
9-12:
13 and up ?
Meaning -
Scores depend on what?
Use glascows coma scale if head injury occurs: 3-8 = severe injury of head, 9-12= moderate injury, 13 and up = normal.
Scores depend on Eye opening, verbal responses, and motor responses.
Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes.
is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes.
It is a potential complication of all types of seizures.
Seizures lasting longer than how long can cause death!?
o Status epilepticus
Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes.
10 minutes can = death
Common causes of status epilepticus include:
- Sudden withdrawal from antiepileptic drugs
- Infection
- Acute alcohol or drug withdrawal
- Head trauma
- Cerebral edema
- Metabolic disturbances
Nursing Safety Priority
Critical Rescue
Convulsive status epilepticus must be treated promptly and aggressively!
How?
Priority?
What may occur if untreated?
Drug of choice?
Establish an airway and notify the health care provider or Rapid Response Team immediately if this problem occurs!
Establishing an airway is the priority for this patient’s care:
- Intubation by an anesthesia provider or respiratory therapist may be necessary.
- Administer oxygen as indicated by the patient’s condition.
- establish IV access with a large-bore catheter and start 0.9% sodium chloride.
- The patient is usually placed in the intensive care unit for continuous monitoring and management.
- Blood is drawn to determine arterial blood gas levels and to identify metabolic, toxic, and other causes of the uncontrolled seizure.
- Brain damage and death may occur in the patient with tonic-clonic status epilepticus.
- If Left untreated, metabolic changes result, leading to hypoxia, hypotension, hypoglycemia, cardiac dysrhythmias, or lactic (metabolic) acidosis.
- Further harm to the patient occurs when muscle breaks down and myoglobin accumulates in the kidneys, which can lead to renal failure and electrolyte imbalance. This is especially likely in the older adult.
- The drugs of choice for treating status epilepticus are IV-push lorazepam (Ativan, Apo-Lorazepam) or diazepam (Valium). Diazepam rectal gel (Diastat) may be used instead.
- Lorazepam is usually given as 4 mg over a 2-minute period. This procedure may be repeated, if necessary, until a total of 8 mg is reached.
Emergency Care:
Acute Seizure and Status Epilepticus Management. Seizures occurring in greater intensity, number, or length than the patient’s usual seizures are considered acute.
They may also appear in clusters that are different from the patient’s typical seizure pattern.
Treatment with lorazepam (Ativan, Apo-Lorazepam) or diazepam (Valium, Meval, Vivol, Diastat [rectal diazepam gel]) may be given to stop the clusters to prevent the development of status epilepticus. IV phenytoin (Dilantin) or fosphenytoin (Cerebyx) may be added
Nursing Safety Priority Drug Alert
- To prevent additional tonic-clonic seizures or cardiac arrest, a loading dose of what is given?
IV phenytoin (Dilantin) is given, and oral doses are administered as a follow-up after the emergency is resolved.
- Initially give phenytoin at no more than 50 mg/min using an infusion pump.
- If the drug is piggybacked into an existing IV line, use only normal saline as the primary IV fluid to prevent drug precipitation.
- Be sure to flush the line with normal saline before and after phenytoin administration
syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).
spinal injuries above T6: stimulation of sympathetic nervous system with inadequate response from parasympathetic nervous system.
Symptoms: EXTREME HYPERTENSION, severe headache, blurred vision, diaphoresis.
o Autonomic dysreflexia
Nursing actions for autonomic dysreflexia:
Sit patient up, notify provider, DETERMINE CAUSE (DISTENDED BLADDER, FECAL IMPACTION, TIGHT CLOTHING, UNDIAGNOSED INJURY), treat cause (catheterize patient, remove impaction, remove tight clothing), administer antihypertensives.
occurs immediately as the cord’s response to the injury.
The patient has complete but temporary loss of motor, sensory, reflex, and autonomic function that often lasts less than 48 hours but may continue for several weeks.
Spinal shock is NOT the same as neurogenic shock.
Perform a detailed assessment of the patient’s what?? status to determine the level of injury??
The neurologic level is determined by evaluation of the ?
Spinal shock
MOBILITY and SENSORY PERCEPTION
evaluation of the zones of sensory and motor function, known as dermatomes and myotomes
o Spinal cord injuries
??-injuries below T1, resulting in paralysis/paresis of lower extremities
??-injuries in cervical region, resulting in paralysis/paresis of all 4 extremities
Paraplegia- injuries below T1, resulting in paralysis/paresis of lower extremities
Quadriplegia- injuries in cervical region, resulting in paralysis/paresis of all 4 extremities
occurs after SCI for several days to weeks.
s/s: low BP, dependent edema, temperature regulation issues.
Upper motor neuron injuries (above L1/L2): spastic muscle tone, spastic neurogenic bladder.
Lower motor neuron injuries (below L1/L2): flaccid muscle tone, flaccid neurogenic bladder.
Meds:
Neurogenic shock
Meds:
Glucocorticoids (reduces spinal cord edema), vasopressors (treats low BP during neurogenic shock) muscle relaxers (baclofen, dantrolene), stool softeners (in addition to bowel and bladder schedule).
In acute SCI, monitor for a decrease in ??
The presence of these changes is considered an emergency and requires immediate communication with the primary health care provider using SBAR or other agency-approved protocol for notification.
Document these assessment findings in the electronic -health record.
SENSORY PERCEPTION from baseline, especially in a proximal (upward) dermatome and/or new loss of motor function and MOBILITY.
Diagnosis of / manifestations of thyroid disorders
H
Diagnosis of manifestations/ tx of parathyroid disorders in
?
Manifestations of malnutrition/ risk factors for malnutrition
?
Appropriate infusion of tube feedings /TPN
?
Risks for obesity
?
Role of nurse in preparing client for gastric bypass
?
Complications with gastric bypass
?
albumin
?
Inadequate production of thyroid hormones t3 t4 by the thyroid gland
Hypothyroidism
S/s of hypothyroidism
Labs:
Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle finger nails, depression
Decreased t3 and t4 , increased TSH, anemia
Causes of hypothyroidism
Primary
Secondary
Tertiary
Most common type -issue with thyroid gland - autoimmune disorders
Issue with pituitary gland- insufficient TSH- tumor
Issues with hypothalamus- produces improper Amt of TRH
Hypothyroidism nursing care
Meds
Encourage proper rest periods
Low calorie, high fiber and increased activity to promote weight loss and prevent constipation
Non fiber laxatives- interferes with levothyrixine absorption
Provide extra blankets and increase room temp
No electric blankets
Meds- levothyrixine (synthroid) start low dose and gradually increase. Take one hour before breakfast with full glass Of water
Complications of hypothyroidism
Causes:
Symptoms of complications:
Nursing care for complications:
Hyperthyroidism due to too much synthroid
Myexedema coma - severe hypothyroidism
Causes: untreated Hypothyroidism, infection/illness, Stopping Synthroid abruptly
S/s: hypoxia, decreases cardiac output, decreased LOC, Bradyycardia, hypotension , hypothermia
Nursing care: maintain airway, monitor ECG, warm patient , administer large doses of Synthroid
Excess thyroid hormones (too much) T3 and T4 released from the thyroid gland, resulting in hyper metabolic state
Hyperthyroidism
Causes of hyperthyroidism
Primary
Secondary
Tertiary
Primary -issues with the thyroid gland,Graves disease is most common, auto immune issue or Thyroid nodule has hyper secretion of T3 and T4
Secondary – issues with the pituitary gland. Anterior pituitary gland produces too much TSH due to tumor
Tertiary – issues with the hypothalamus. Hypothalamus produces too much TRH
Signs and symptoms of hyperthyroidism
Labs
Tachycardia, hypertension, heat intolerance is key, EXOphthalmos,Weight loss, insomnia, diarrhea, warm and sweaty skin
Labs-Increased T3 and T4, decreased TSH
Nursing care for hyperthyroidism
Nutrition is key to increase patient calories, protein intake, and monitor I and Os , weight
Exophthalmos- tape eye lids closed, provide eye lubricant
Hyperthyroidism meds
PTU
Beta blockers
Iodine solution’s- mix with juice to mask taste
Radio active iodine- stay away from children for 2-4 days, flush toilet 3 times, do not share toothbrush , use disposable plates/utensils
Hyperthyroidism complications
Cause
Symptoms
Thyroid storm-Excessively high levels of the thyroid hormones, with high mortality rate
Causes – infection, stress, DKA
Symptoms – hypertension, chest pain, dysrhythmias, dyspnea, delirium
Surgery for hyperthyroidism
What to inform patient
Thyroidectomy-Removal of thyroid gland
Patient will need a ride replacement therapy for the rest of their life
Thyroid synthesis pathway
The hypothalamus produces TRH – thyroid releasing hormone
TRH causes the anterior pituitary gland to produce TSH – thyroid stimulating hormone
TSH causes the thyroid gland to produce T3 and T4-thyroid hormones that control metabolism in the body
Cortisol synthesis pathway
Hypothalamus purchases CRH – cortisol releasing hormone
CRH causes the interior pituitary gland to produce ACTH (adrenocorticotropic hormone)
(ACTH causes the adrenal vortex to produce cortisol. - A steroid hormone that controls metabolism, immune function, and body’s response to stress
Inadequate secretion of hormones by adrenal cortex (Sex hormones, cortisol, aldosterone)
Addisons
Causes of Addisons
Primary
Secondary
Primary- adrenocortical insufficiency: Damage or dysfunction of adrenal cortexRelated to autoimmune dysfunction’s, tumors
Secondary- Pituitary dysfunction: pituitary tumor or hypophysectomy
S/s of addisons
Labs
Weight loss, hyperpigmentation- bronze skin, lethargy, n/v , hypotension, dehydration
*increased potassium and calcium
Decreased sodium, glucose, cortisol
Dx Addisons how
Primary-results
Secondary-results
ACTH simulation test
Administer AC TH, measure Cortizone response after 30 minutes, one hour
Primary-Cortisol levels do not rise
Secondary-Cortisol levels do rise
Nursing care for Addisons
Give steroids-prednisone/hydrocortisone
Fluids
Treat hyperkalemia-sodium polystyrene sulfonate, insulin with glucose, calcium, bicarbonate
Treat hypoglycemia- food, supplemental glucose
Complications of Addisons
Addisons crisis - Rapid onset, medical emergency. Due to infection/trauma or abrupt discontinuation of steroids
Over production of cortisol by the adrenal cortex
Cushings
Dx for cushings
Dexamethasone suppression test
Nursing care for Cushings
- diet: Decrease sodium intake, increase and take a potassium, calcium and protein
Maintain safe environment due to increased risk of fracture’s
Prevent infection
Protect patient skin from break down
Cushings meds :
Procedures/surgeries:
Spironolactone - potassium sparring diuretic
Ketoconazole- adrenal corticosteroid inhibitor
Procedures/surgeries :
cytotoxic agents for tumors
Hypophysectomy- removal of pituitary gland
Adrenalectomy - removal of adrenal gland- hormone replacement therapy needed , monitor for adrenal crisis related to drop in cortisol levels
Cushings causes
Primary
Secondary
Primary : Adrenal dysfunction – oversecretion of cortisol by the adrenal cortex related to hyperplasia or tumor
Secondary- Pituitary dysfunction- Oversecretion of AC TH by the anterior pituitary gland related tumor
Long-term steroids use for chronic conditions
Signs and symptoms of Cushing’s syndrome
Labs
Increased infections, thin and fragile skin, edema, wt gain, Moon face, Buffalo hump, increased abdominal girth, hypertension, tachycardia, bone pain fractures, hyperglycemia, gastric ulcers, acne, hirsutism
Elevated cortisol levels in saliva
- Increase glucose, sodium levels
- Decreased potassium, calcium levels
Thyroidectomy - post procedure nursing care
Place Patient in high Fowlers position
Monitor for hemorrhaging.
Check the dressing and back and neck for bleeding.
Support head and neck with pillows/sand bags
Teach patient to avoid neck flexion or extension
Have a tracheostomy supplies available at bed side
*Monitor for signs of parathyroid gland damage(low calcium , numbness around mouth , toes, muscle twitching , positive chvosteks or trousseus signs
Administer calcium gluconate for treatment of hypocalcemia
Administer steroids to decrease post op edema
Hypophysectomy post op nursing care
Monitor for s/s of CSF leak :
Halo sign in drainage (clear in center, yellow on edges )
- sweet tasting drainage
- clear drainage from nose
- headache
Teach patient to avoid activities increased ICP: coughing, sneezing,Blowing nose, bending at Waist, Straining during bowel movements, increase fiber intake
Decrease sense of smell expected for 3 to 4 months
Do not brush teeth for two weeks but can floss and rinse mouth
Spinal cord injury - how to move patient
What is the purpose of it
Log roll- A couple people at had a bed, brace and mobilization at neck
purpose of logrolling is to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury.
