Test 3 Flashcards
1
Q
Contusion
A
bleeding into soft tissue
results from blunt force and commonly causes bruising leaving a black and blue mark
2
Q
ecchymosis
A
bruising (usually black and blue)
3
Q
Hematoma
A
contusion with large amount of bleeding that causes a lot of bleeding and swelling that form a blood clot.
4
Q
strain
A
stretching injury to a muscle or muscle tendon caused by mechanical overloading.
a common place to strain is the back
stretched a little farther than it should be
5
Q
sprain
A
injury to a ligament surrounding a joint
sprains occur in joints, over stretching and tearing of ligaments
ankles and knees are common sprains
6
Q
treatments for contusions, hematomas, strains and sprains
A
RICE
Rest- immobilization, the body needs to rest to avoid further injury and promote healing
Ice- for the first 24 hours, soft tissue injuries we need to decrease the amount of swelling caused by damage and bleeding into the tissue. ice constricts blood vessels which reduces swelling. after 24 hours we want an increase in blood flow.
Compression- wrapping and splinting keeps tissue constricted so there is less swelling and supports ligaments
Elevation- above the level of the heart- this way excess fluid can drain back to the body- GRAVITY!
7
Q
Surgery for soft tissue injuries
A
ACL, Meniscus, MCL, LCL tears require surgery.
otherwise PT works well for soft tissue injuries
8
Q
Diagnostic tests for soft tissue injuries
A
taken to make sure nothing worse has happened
X-ray-r/o fracture, shows bone not tissue
MRI-will show soft tissue damage, is more expensive than a CT scan
CT scan- will show soft tissue damage, Is less expensive than an MRI but buts out MUCH more radiation
9
Q
Meds for soft tissue injuries
A
analgesics- most commonly given to start with then told to switch to NSAIDS
NSAIDS- decrease the inflammation and help with pain
muscle relaxants- given to help with pain from muscles tightening to protect joints
10
Q
Nursing diagnosis for soft tissue injuries
A
acute pain
impaired physical mobility
self care deficit
risk for impaired skin integrity
11
Q
Dislocation
A
loss of articulation of bone ends in the joint following severe trauma
the two ends of the bone that are supposed to be lined up are not anymore
most common site is the shoulder
assess 5 Ps, Immobilize, and pain relief
12
Q
5 Ps assessment
A
Used to assess Neurovascular responses and circulation in dislocations and fractures Pain Pulse Pallor Paresthesia Paralysis
13
Q
Subluxation
A
a partial dislocation, still can be very painful, provide pain relief
limited mobility
14
Q
Fracture
A
Any break in the continuity of bone- bone is subjected to more kinetic energy than the bone can absorb
15
Q
why do dislocations and fractures occur?
A
when bones are subjected to more kinetic energy than the bone can absorb. something has to give.
either the joint= dislocation or the bone= fracture
strong forces are applied from directions that aren’t supposed to happen and cause injury
16
Q
Simple fracture
A
no break in skin- skin is intact over fracture
17
Q
compound/ open fracture
A
skin is open over fracture
problem with bacteria- increased risk for infection
usually goes to surgery
18
Q
complete fracture
A
entire width of bone
19
Q
incomplete fracture
A
partial width of bone
20
Q
comminuted
A
broken in many places
21
Q
compressed bone
A
the bone is crushed- similar to comminuted but more crushing look to fractures than several straight ones
22
Q
stable/non-displaced
A
bones maintain alignment. they stay lined up
just need a cast for 6 weeks or so
23
Q
unstable/ displaced fracture
A
bones move out of correct alignment due to muscle spasms. may need surgery, traction or manipulation.
occur near joints
bones over ride each other.
24
Q
stress/pathologic fracture
A
disrupted bone homeostasis and inadequate repair in the face of repetitive overload
25
Manifestations of fractures (evidence that is seen with fractures)
may have soft tissue injury- soft tissue includes torn muscles, tendons ligaments, arteries, veins, nerves and skin.
may have alteration in circulation, sensation, etc- might not have strong pulses beyond the fracture site. check for 5ps.
may have obvious deformity- fx hip, one leg shorter than the other (x-ray to see full extent of damage)
may have felt cracking or popping sound when taking hx of injury the pt may state that he/she felt a snap or heard a crack.
26
Fracture healing
```
inflammation phase (bone injury)
reparative- callus forms
remodeling
```
27
inflammation phase
reactive phase- first 24-48 hours
bleeding at site (causes hematoma around fx) may not see bruising right away- depends on how deep the bone is
the collection of blood around the fx causes the osteoblasts to migrate out and triggers them to build bone
28
Reparative phase
```
callus forms
2-3 weeks soft callus
4-8 weeks hard callus
2-3 months for repair
a couple of weeks after the fx an x ray will show a thin shell around the injury where bone is being built which is called a callus.
```
29
remodeling phase
new bone Is laid down
most of bone callus is reabsorbed, but xray will show where the bone is a little thicker and always will be
takes about a year
30
osteoblasts
build bone
| continue to form new woven bone- compact bone
31
osteoclasts
cracking down
continue to dissolve away callus as it is replaced by mature bone
may take a year or more
32
Fracture healing influenced by
co morbidities
age, health and nutrition, elderly don't heal as well as young people
elderly and frail don't heal as well r/t poor nutrition and health
types of fractures influence healing
spiral comminuted fx take much longer than a simple fx to heal.
33
arms, ankle and feet fracures heal in how long
6-8 weeks
34
legs and hips heal in how long?
12-16 weeks
35
Emergency care of fracture
immobilization- avoid causing further injury- immobilize the joint above and below the injury. don't move patient until splinted to maintain alignment as is.
maintain tissue perfusion-if bleeding put direct pressure on the wound even though there is a risk of increased injury
open wounds- sterile dressings
elevate if possible.
36
diagnostic tests for fractures
history of incident and assessment
x-ray of bones
additional tests- lab work to rule out pathological fractures
37
medications for fx
pain meds- narcotics ( Tylenol 3, Norco, Percocet) may be written for first few days
NSAIDs- after patient is more comfortable patient will be switched to NSAIDs to reduce swelling and help with pain. beware of bleeding- it may interfere with inflammatory phase of healing.
antibiotics- for open fractures (break in skin) usually patient is admitted so they receive IV antibiotics
38
other meds for fx (think about other complications)
```
anticoagulants r/t immobility
stool softener r/t immobility and narcotics
antiulcer
multivitamins- help rebuild bones
calcium- helps rebuild bones
vitamin D- helps absorb calcium
```
39
surgery for fractures
some fractures require surgery
used for displaced fractures, soft tissue damage involving nerves, tendons, ligaments, blood vessels
ORIF
40
ORIF
open reduction internal fixation
open reduction- surgical incision down to the bone and reduce the fx by lining it up commonly using hardware (pins, plates, screws)
internal fixation= screwed the two pieces of bones together using a plate with screws above and below. this doesn't mean the bone is healed it is only lined up and fastened together so that it can heal properly.
41
Traction for fractures
not used much anymore r/t insurance companies don't want to pay for pts to be hospitalized that long.
application of straightening or pulling force to maintain or return fractured bones in normal alignment, prevent muscle spasms
weights- maintain necessary force- don't touch or remove.
42
types of traction
straight- pulling force in straight line ( bucks extension)
uses tape on skin to pull
skeletal traction- involves one or more force of pull- don't remove weights
hardware in bone.
43
assessment of complications for immobility include
circulation in toes, pulses, cap refill, skin breakdown, infection in sites, fluid intake, constipation
44
casting
rigid device applied to immobilize bones and promote healing
| extends above and below fracture
45
plaster cast
needs 48 hours to dry
stockinette on skin then plaster
doesn't reach total hardness for 48-72 hours
46
fiberglass cast
used in ER for non-displaced fx
| hardens in 1 hour
47
assessments after cast is applied
assess pulses, circulation cap refill skin breakdown r/t rough edges of casting material, keep pt and cast dry, keep pt warm while plaster is drying
teach them not to shove anything into cast or it can cause injury
48
electrical bone stimulation
promotes healing- increases osteoclasts and blasts activity
49
complications of orthopedic injuries
fx will swell if kept hanging down especially for the first couple of weeks- needs elevation
50
compartment syndrome
excess pressure in a limited space which constricts the structures inside and reduces circulation to the muscle and nerves.
decreases blood flow-ischemia and damages nerves
VERY serious
develops within 24-72 hours of injury
51
signs of compartment syndrome
increase pain distally (because O2 can't get to tissue
not relieved with pain meds
INCREASED pain DECREASED sensation
52
interventions for compartment syndrome
if r/t casting- bivalve cast- leave cast on but spread both sides
fasciotomy- cut muscle fascia to relieve pressure and increase bld flow
emergency situation- may leave open and then suture later
53
Fat embolism sydrome
occurs in fx of long bone shafts (femur, tibia and humerus) theory is their diaphysis is filled with yellow marrow which leaks out when the bone is broken
fat gobules enter the blood stream through broken blood vessels and travel to lungs where they clog capillaries around alveoli.
inadequate perfusion results
54
signs and symptoms of fat embolism syndrome
neuro symptoms- confusion, restlessness
cyanosis- fluid builds up around alveoli- pt doesn't profuse enough O2
dyspnea- PO2 starts to drop
petechial- little tiny hemorages on chest upper arms and axilla and inside mouth
develops in a couple hours to a couple of days after injury
55
FES may result in
pulmonary edema and ARDS
56
prevention of FES
stabilize fx
| monitor for signs and symptoms
57
DVT
deep vein thrombosis- a blood clot usually in usually in the leg
may lead to pulmonary embolism
pt doesn't always have symptoms of DVN
can happen from any type of fx
about 60% of hip fx will end up with VTE/DVT
58
prevention of DVT/VTE
early immobilization
| early abulation after fixed
59
tx for DVT/VTE
```
don't want the clot to travel
body will absorb clot eventually
anticoagulants
TED hose/ SCDs- before DVT occurs
Teds prevent DVT from getting bigger
```
60
infection and fx
expecially common with compounds
many compound fx go to surgery to be irrigated
and for debridement to prevent infection
assess for warmth drainage and redness
osteomyelitis is for LIFE
61
delayed or non union
fx doesn't heal within normal amount of time
| non union- heals as two separate bones, one heals but the other one dies
62
risk factors, why don't fx heal like they should
```
poor nutrition-
inadequate immobilization
poor alignment
prolonged reduction time
infection
necrosis
elderly
immunosuppressed patient
severe bone trauma
```
63
treatments for delayed or non union
surgery- bone graft
electrical stimulation for osteocyte production
if infection- MD will debried, remove dead bone and hope it heals
64
RSD (reflex sympathetic dystrophy)
poorly understood condition.
causes problems with nerves and muscles has o do with sympathetic nervous system
neuropathic pain
65
signs and symptoms
```
fx heals well but pt has severe pain
person has hyperperesthesia (can't have area touched)
swelling
change in skin color
decreased movement
pt gets atrophy from lack of use
```
66
treatment
unknown
| sometimes use nerve blocks to decrease pain but this doesn't increase function
67
pain management nursing care with ortho injuries
many times pain comes from not elevating like pt should.
orthopaedic injury needs most distal part elevated the highest (above the heart)
leg on footstool is not elevated, must be above heart.
always ask patient to describe pain- if patient has decreased circulation or compartment syndrome they will have a different kind of pain than fx pain.
68
Impaired physical mobility nursing care
discharge planning should include plans for at home care especially with leg injuries.
crutches require balance and upper body strength
elderly require walker instead
pt cant get up from middle of couch- need arm rests
cant use stairs well
assistance with bathing
69
impaired tissue perfusion nursing care
some patients pay be admitted just for this reason
check 5Ps
look for pressure ulcers
70
neurovascular compromise
circulation checks, cap refil, circulation (5Ps), swelling, reassess pain and sensation
71
assessment of clients response to trauma
psychosocial needs: is patient afraid to drive again if injury is car accident related
is patient afraid to walk again?
physical psychological and social needs assessed
changes in ADLs
Changes at home
72
health promotion r/t ortho injuries
maintain good bone health
take calcium when young 1200-1500mg of Ca++/day from day one not once we get old
weight bearing exercises- bones get stronger with stress- walking is great
avoid obesity- hard on joints
73
nursing dx for ortho injuries
```
acute pain
risk for peripheral neurovascular dysfunction
risk for infection
impaired physical mobility
risk for disturbed sensory perception
```
74
home care: client teaching
cast care- don't stick stuff into cast, keep it dry, cover rough edges, report drainage/odors, call office if cast cracks
following orders-weight bearing!
ROM of unaffected joints- move fingers, toes, elbows, shoulders, knees, hips.
elevation to decrease swelling and pain-if limb is throbbing it isn't being elevated enough, elevate for an hour and assess pain.
discharge planning-needed equipment, walker, wheelchair, high rise toilet, do they have stairs at home, PT/OT appt
75
amputation
a partial or total removal or body part- results from traumatic event (major cause of upper extremity amputation) or chronic condition usually secondary to chronic condition.
PVD is a major contributor as well as diabetes, infection also
76
Causes for amputation
IMPAIRED BLOOD FLOW AND POOR CIRCULATION
PVD/PAD- poor circulation- diabetes is a risk factor
Trauma- especially upper extremity amps. include:
frost bite-fingers and toes
burns-lack of blood supply r/t damaged blood vessels
electrocution
severe infection
smokers- HTN- vasoconstricts
77
Underlying causes for amputation
interrupted blood flow
either acute or chronic
acute-frostbite, burn, electrocution, arm ripped off in accident
chronic- poor circulation causing gangrenous tissue- have to amputate above bad tissue
many times need to amputate leg above the knee
78
Goals with amputation
alleviate symptoms- to stop hemorrhage, to correct chronic severe pain from ischemia
maintain healthy tissue- must amputate above and into healthy tissue, drains placed to prevent infections
increase functional outcome- a prosthesis may make leg more functional compared to a numb infected foot or malformed foot
79
site healing for amputations
assess circulation-is incision healing? how does it look? color pink temperature
rigid or compression dressings - prevent infection and minimize edema, move soon after surgery
stump is wrapped in ACE wrap to allow a conical shape to form and prevent edema: applied distal to proximal extremity
most likely to be able to fit into a prosthetic if a good shape is formed
be aware of strong flexor muscles- turn patient from supine to prone to work extensor muscles to prevent contracture
80
Complications with amputations
infection- poor circulation
delayed healing if circulation isn't good
chronic stump pain- r/t putting weight on the incision site
phantom limb pain- sensation below the amputation site, narcotics do nothing for it, pain is very real, treated with adjuvant meds such as Neurontin and Elavil (neuro pain)
Contractures- reposition q2 hours, hyper extend the muscles, contractures usually associated with AKA
81
repetitive use injuries
carpal tunnel syndrome
| bursitis
82
carpal tunnel syndrome
is compression of the median nerve at the wrist- the nerve gets pinched in the carpal tunnel caused by repetitive use
s/s numbness and tingling in the thumb and index finger, curling hands while sleeping makes the pain worse at night, weakness in the hand r/t numbness
83
bursitis
inflammation of bursa (an enclosed synovial fluid filled sac near a joint which allows movements of muscles without the muscles getting caught on each other) problems occur in the shoulders hips knees and elbows
s/s caused by repetitive actions such as painting bending and straightening
joint tenderness
warm to touch
reddened
swollen near bursa
pain when joint flexes
84
meds for repetitive use injuries
injections of steroids- not done often, steroids can make the joint degenerate (breaks down cartilage
NSAIDS- Rx strengths taken on a regular basis- anti inflammatory effect helps with pain
85
treatments for repetitive use injuries
conservative- immobilize joint with splinting, slings, and rest. ice heat and xray to check with other injuries
surgery- if conservative treatment doesn't work then surgery is the next step.
carpal tunnel- an incision is made in the wrist and the tunnel is enlarged. the wrist is splinted for several weeks to decrease movement and hopefully decrease scar tissue.
bursitis- remove the bursa- won't cause long-term complications
86
nursing diagnosis for repetitive use injuries
acute pain
impaired physical mobility
self care deficit
87
Osteoarthritis discription
also called degenerative joint disease
most common form of all arthritis, males are effected more than females until age 55 then the incidence becomes twice as high in females.
88
risk factors for osteoarthritis
age, inherited, excess weight, inactivity, strenuous repetitive exercise, hormone factors.
89
pathophysiology of osteoarthritis
when a person has osteoarthritis the cartilage that lines the joints disintegrates leaving bone exposed, those pieces of bone rub against each other and develop spurs called osteophytes- these cause pain and limit mobility.
90
signs and symptoms of osteoarthritis
```
the onset is gradual
pain and stiffness in one or more joints
decreased ROM
when the joints are moved grinding noises are heard which are called crepitus
joint enlargement
```
91
meds for osteoarthritis
Tylenol- best medication early on
NSAIDs-some tolerated better than others.
Steroids/Corticosteroid joint injections- can increase the rate at which the joint deteriorates
92
conservative treatment for osteoarthritis
```
PT
Heat/Ice
Rest
Ambulation devices
Weight loss
Meds- analgesics and anti-inflammatory
```
93
Surgery for osteoarthritis
knees and hips are the most common replaced- they get the most wear and tear
94
complementary therapies for osteoarthritis
bio-electromagnetic therapies- magnet bracelets, wraps etc.
eliminate foods in the "night shade" family- potatoes, tomatoes, peppers, eggplants, and tobacco
nutritional supplements- glucosamine, chondroitin
osteopathic manipulation-chiropractors
yoga
95
nursing care for osteoarthritis
promote comfort- heating pads
maintain mobility-swimming
assist with adaption of lifestyle- OT consults
96
nursing diagnosis for osteoarthritis
chronic pain
impaired physical mobility or limited mobility
self care deficit
97
low back pain cause
most often due to strain of muscles and tendons of back caused by abnormal stress or overuse
very common complaint of nurses
common reason people see doctor
80% of people will have low back pain at some point in their life
98
pathophysiology of low back pain
usually in lumbar area
local pain due to compression, stretching or swelling of tissue around it that puts pressure on or causes irritation of the sensory nerves
when nerves are irritated they send out pain signals and the muscles spasm
99
radicular pain
seen with herniated disc, aggravated by movement, caused by pressure on nerve. very painful
100
treatment for low back pain
```
rest
NSAIDs
pain clinic
limited time, no strenuous work
pt feels best laying in bed with HOB raised a little with knees lightly flexed- low fowlers position
heat ice
PT
```
101
Herniated disc definition
rupture of intervertebral disc with protrusion of nucleus pulposus (thick goo)
pain associated with a herniated disk is usually on only one side of the back and radiates down extremities.
102
most common sites of herniated disks
L 4-5
L5-S1
C5-6
103
pathophysiology of herniated disks
protrusion- occurs spontaneously or as a result of trauma
abrupt herniation- causes intense pain and muscle spasm- radiating pain down legs
gradual herniation- occurs when a worn out disk becomes flat and the bones above and below it slip back and forth this creates bone spurs
104
s/s of lumbar herniated disc
recurrent pain in lower back butt and legs, radiating pain Is called radicular pain
pt has weakness on affected side
foot drop
paresthesias
105
s/s of cervical herniated disks
```
pain in shoulder, arm, neck
weakness
weak hand grips
parasthesia
muscle spasm
```
106
Meds for herniated disks
analgesics NSAIDS muscle relaxers narcotics pain clinics
107
muscle relaxers for herniated discs
robaxin
flexaril
valium
cause a lot of drowsiness
108
treatment for herniated disk
conservative for 2-6 weeks
decrease activity
take medications
PT, massage, heat packs
109
Laminectomy
used for herniated disks
lamina is the bone that is partially or wholly removed to create access to the herniated disc to be able to remove the nucleus
pts pain may be worse right after surgery
110
discectomy
the surgeon doesn't remove he disc- just the herniated portion (nucleus pulposus) if the whole disk was removed it would be bone on bone
111
decompressive laminectomy
removal of bone from both sides of the spinous process
usually at 3 or 4 levels
decompresses pressure on spinal cord
112
Spinal fusion
usually done in lower back
so much bone removed that it needs to be replaced because the back and neck aren't stable anymore
replaced with cadaver bone
a spinal fusion increases the patients hospital stay
must wear a brace
113
spondylolisthesis
any forward slipping of one vertebra on the one below it
114
spondylolysis
breaking down of vertebral structure
115
Shingles
herpes zoster- caused by the virus that causes chicken pox
when a person is infected with the virus they get chicken pox then the virus goes dormant and lives in the dorsal root ganglia (nerve root) never leaves body
IF YOU GET SHINGLES YOUVE HAD CHICKEN POX
116
Chicken pox vaccine
prevents people from getting chicken pox, which in turn prevents them from getting shingles
If a person has never had chicken pox nor the vaccine and come into contact with shingles they can get chicken pox
117
People at risk for shingles
```
usually effects people greater than 50 years of age, who are immunocompromised
chemo
elderly
have mono/cold/flu
immunity is decreased when stressed
```
118
Signs and symptoms of shingles
the virus lives in nerve root (in spine) so itching along the backbone
areas feel tingly
after a few days blisters/lesions form
if scratched a lot the blisters break open releasing the virus- contagious
VERY painful lesions that erupt for 3-5 days then crust over
119
how long does shingles last?
can last for up to 6 weeks
but patient can have post herpetic neuralgia (pain in the nerve) can have pain along the nerve root for 6 months or more
Sometimes use nerve block to decrease pain
120
Treatment for shingles
if caught early acyclovir (zovirax), valacyclovir (Valtrex) can be given
may need nerve block
may need abx r/t secondary bacterial infection from scratching
121
prevention of shingles
zostavax- a new vaccine available for people over 60 years old who have had the chickenpox (carry the virus) may prevent the disease from occurring or lessen the severity of it.
122
nursing diagnosis for shingles
acute pain
disturbed sleep pattern
risk for infection
123
Migraine headaches
something causes blood vessels inside the SKULL (not brain) to dilate which puts pressure on the meninges and inside of skull
this causes a throbbing HA
recurring vascular headaches
124
pathophysiology of migraines
abnormalities in cranial blood flow
brain activity
release of serotonin
125
triggers for MHA
stress
fluctuating blood sugars (skipping meals)
hormones (common in women during child bearing years a few days before menstruation starts r/t drop in estrogen levels)
bright and/or flashing lights
fatigue
126
Aura
about 20% of migraine sufferers develop an aura which is a warning sign of MHA the aura can be flashing in the eyes, spots in the eyes etc.
127
s/s of MHA
```
pale
sensory/motor/mood disturbances
the HA is usually one sided
pain is anterior, above eye, throbbing
dizziness/lightheadedness
Nausea and Vommiting
HA last a couple of hours to several days
hypersensitivity to light and sound
post MHA exhaustion and sensitive to touch
```
128
Abortive medications for MHA
NSAIDs, asprin, narcotics (although they usually don't work for dilated vessels)
Migraine specific drugs- constrict blood vessels
Cafergot, Excedrin Migraine ( have caffeine in them)
Triptan meds- imitrex- constricts blood vessels which increases BP so not good for pts with HTN, decreases inflammatory effects. oral, nasal and sub Q
129
Prophylaxis or preventative meds
to prevent MHA from occurring- must be taken on regular basis
Beta blockers- lols, BP meds
Inderal, depecote, and Elavil
MUST BE TAKEN ON REGULAR BASIS
130
nursing care for MHA
pain meds, room dark and quiet, education- regarding preventative meds and triggers, avoiding red wine, pay attention to diet
131
Seizures definition
episodes of abnormal, sudden, excessive discharge of electrical activity within the brain
epilepsy is a type of seizure but not all seizures are epilepsy
132
idiopathic seizures
don't know why they happen, can be genetic or developmental issues
133
acquired seizures
```
secondary to something causing the seizure
head injuries
CNS infections
brain tumors
birth trauma
renal failure
alcohol withdrawal
electrolyte problems
heart disease
medications
high fevers in kids
```
134
prevention of seizures
monitor high risk pregnancies- preemie doesn't head doesn't have much bone protecting brain
control lead poisoning
prevent childhood disease- GET IMMUNIZED
prevent head injuries
135
generalized seizures
pt loses consciousness
136
tonic-clonic (grand mal) seizures
| generalized
has THREE stages- last for a few seconds to 5 minutes
may be preceded by aura
stiffens, rigidity (tonic phase)
loses consciousness and falls down with rhythmic jerking may be incontinent, and bite tongue (clonic phase)
then post ictal stages where the pt starts to gain consciousness, confusion, fatigues, sleepy which lasts for hours
250% more energy required for siezures
137
absence (petit mal)
| generalized
more common in elementary aged children, pt stares into space loses consciousness for a few seconds- doesn't fall
can happen 100x a day
138
partial seizures
does not affect the whole body
139
simple partial seizures
one arm jerking, doesn't necessarily lose consciousness, and can be aware of the jerking
140
complex partial seizures
pt does something odd (lip smacking, picking at something, patting something) for several minutes and is unaware that he/she is doing it.
don't necessarily lose consciousness
141
status epilepticus
Lasts more than 5 minutes
is seizure activity (tonic-clonic) that lasts longer than 30 minutes or is a series of seizures that keep recurring
pt needs medical assistance
effects resp. muscles too- death
KEEP AIRWAY CLEAR- ONLY put O2 on patient
prevent injury
IV meds - benzos and muscle relaxers (Ativan and valium versed)
assess pt
142
occurrence of seizures
vary in frequency
absence- can happen 100x a day
tonic clonic- can happen every few weeks or once in a life time
143
attacks can be precipitated by
```
excitement
anger
menstruation
fatigue
some meds can lower seizure threshold
brain tumors/scar tissue
```
144
treatment during attacks
prevent from injury-do not restrain
stay with pt
no tongue blades
bed in lowest position or lower patient to the floor
turn head to side
loosen tight clothing
o2 and suction equipment set up at bedside
145
nursing diagnosis for seizures
altered cerebral tissue perfusion
altered self image
low self esteem
146
medications
don't always control seizures
usually need a combination
Dilantin- most common- major side effects gingival hyperplasia
phenobarbital- used for febrile seizures in kids,
tegretol
Depakote
keppra
147
simple head injuries
meaning minor
| minor head injuries loss of consciousness for a few minutes
148
concussion
```
temporary loss of neuro function with complete recovery
pain in the head
dizziness
vomiting
lose consciousness but regained quickly
can't remember the incident
```
149
Closed Head Injury
can have skull fx with no brain injury and can have a brain injury with no skull fx
150
contusion of the brain
bruising of the brain, a little worse than a concussion
sometimes bleeding on the surface of the brain takes a while to develop
may need to admit for obs
neuro checks and VS
assess for increase IICP
151
IICP increased intracranial pressure s/s
less and less responsive
BP with IICP widening pulse pressure
pupils start to dilate
IICP is not a simple head injury anymore
152
epidural bleed
```
between skull and dura
usually caused by tear or damage to an ARTERY
goes alert to unconscious very quickly
vomiting and dizzy
extreme emergency- stop the bleed
goes to OR right away
```
153
subdural bleed
beneath the dura, between the dura and the brain itself
VENOUS bleed
less of an emergency
neuro check VS
surgery
can take 1-2 weeks for a slow bleed to show
confusion, dull headache hemiplegia seizures, personality changes, balance issues
154
intracerebral bleed
bleed into brain tissue
cause trauma or high BP
abrupt onset- headach to unconscious
not safe to do surgery tight away
155
trigeminal neuralgia
chronic disease of trigeminal nerve - caranial nerve 5
SEVERE FACIAL PAIN
Eye, cheeks, jaw
trigger zones
156
meds for trigeminal neuralgia
tricyclic anticonvulsants- tegretol
Dilantin
Neurontin
muscle relaxants
157
surgery for trigeminal neuralgia
rhizotomy- needle with electrocurrent
158
Bells palsy
disorder of cranial nerve 7 resulting in paralysis of face
| pain behind ear or jaw, onesided numbness, impaired taste
159
meds for bells palsy
antiviral-acyclovir
| anti-inflammatory- prednisone
160
polyneuropathy
more than one area effected
| simultaneous malfunction of many different nerves
161
mononeuropathy
isolated peripheral neuropathy- affects a single nerve (carpal tunnel, shingles, leg falls asleep aka compression mononeuropathy.
162
Visceral (autonomic) neuropathies
CV – no increase in HR with exercise
GI – gastroparesis (change in motility), constipation, N&V, loss of control
GU – inability to empty bladder completely, loss of sensation of full bladder, sexual dysfunction (includes ED)
(With DM neuropathy results from neuro and vascular problems
163
meds for neuropathy
Neurontin, Lyrica, Cymbalta- most commonly used, capsaicin cream
