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.
