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NUR 103 > Test 3 > Flashcards

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

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2
Q

ecchymosis

A

bruising (usually black and blue)

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3
Q

Hematoma

A

contusion with large amount of bleeding that causes a lot of bleeding and swelling that form a blood clot.

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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

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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

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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!

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7
Q

Surgery for soft tissue injuries

A

ACL, Meniscus, MCL, LCL tears require surgery.

otherwise PT works well for soft tissue injuries

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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

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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

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10
Q

Nursing diagnosis for soft tissue injuries

A

acute pain
impaired physical mobility
self care deficit
risk for impaired skin integrity

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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

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12
Q

5 Ps assessment

A 
Used to assess Neurovascular responses and circulation in dislocations and fractures
Pain
Pulse
Pallor
Paresthesia 
Paralysis
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13
Q

Subluxation

A

a partial dislocation, still can be very painful, provide pain relief
limited mobility

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14
Q

Fracture

A

Any break in the continuity of bone- bone is subjected to more kinetic energy than the bone can absorb

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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

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16
Q

Simple fracture

A

no break in skin- skin is intact over fracture

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17
Q

compound/ open fracture

A

skin is open over fracture
problem with bacteria- increased risk for infection
usually goes to surgery

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18
Q

complete fracture

A

entire width of bone

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19
Q

incomplete fracture

A

partial width of bone

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20
Q

comminuted

A

broken in many places

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21
Q

compressed bone

A

the bone is crushed- similar to comminuted but more crushing look to fractures than several straight ones

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22
Q

stable/non-displaced

A

bones maintain alignment. they stay lined up

just need a cast for 6 weeks or so

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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.

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24
Q

stress/pathologic fracture

A

disrupted bone homeostasis and inadequate repair in the face of repetitive overload

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25
Q

Manifestations of fractures (evidence that is seen with fractures)

A

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.

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26
Q

Fracture healing

A 
inflammation phase (bone injury)
reparative- callus forms
remodeling
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27
Q

inflammation phase

A

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

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28
Q

Reparative phase

A 
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.
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29
Q

remodeling phase

A

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

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30
Q

osteoblasts

A

build bone

continue to form new woven bone- compact bone

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31
Q

osteoclasts

A

cracking down
continue to dissolve away callus as it is replaced by mature bone
may take a year or more

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32
Q

Fracture healing influenced by

A

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.

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33
Q

arms, ankle and feet fracures heal in how long

A

6-8 weeks

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34
Q

legs and hips heal in how long?

A

12-16 weeks

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35
Q

Emergency care of fracture

A

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.

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36
Q

diagnostic tests for fractures

A

history of incident and assessment
x-ray of bones
additional tests- lab work to rule out pathological fractures

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37
Q

medications for fx

A

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

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38
Q

other meds for fx (think about other complications)

A 
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
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39
Q

surgery for fractures

A

some fractures require surgery
used for displaced fractures, soft tissue damage involving nerves, tendons, ligaments, blood vessels
ORIF

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40
Q

ORIF

A

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.

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41
Q

Traction for fractures

A

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.

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42
Q

types of traction

A

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.

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43
Q

assessment of complications for immobility include

A

circulation in toes, pulses, cap refill, skin breakdown, infection in sites, fluid intake, constipation

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44
Q

casting

A

rigid device applied to immobilize bones and promote healing

extends above and below fracture

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45
Q

plaster cast

A

needs 48 hours to dry
stockinette on skin then plaster
doesn’t reach total hardness for 48-72 hours

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46
Q

fiberglass cast

A

used in ER for non-displaced fx

hardens in 1 hour

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47
Q

assessments after cast is applied

A

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

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48
Q

electrical bone stimulation

A

promotes healing- increases osteoclasts and blasts activity

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49
Q

complications of orthopedic injuries

A

fx will swell if kept hanging down especially for the first couple of weeks- needs elevation

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50
Q

compartment syndrome

A

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

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51
Q

signs of compartment syndrome

A

increase pain distally (because O2 can’t get to tissue
not relieved with pain meds
INCREASED pain DECREASED sensation

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52
Q

interventions for compartment syndrome

A

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

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53
Q

Fat embolism sydrome

A

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

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54
Q

signs and symptoms of fat embolism syndrome

A

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

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55
Q

FES may result in

A

pulmonary edema and ARDS

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56
Q

prevention of FES

A

stabilize fx

monitor for signs and symptoms

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57
Q

DVT

A

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

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58
Q

prevention of DVT/VTE

A

early immobilization

early abulation after fixed

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59
Q

tx for DVT/VTE

A 
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
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60
Q

infection and fx

A

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

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61
Q

delayed or non union

A

fx doesn’t heal within normal amount of time

non union- heals as two separate bones, one heals but the other one dies

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62
Q

risk factors, why don’t fx heal like they should

A 
poor nutrition- 
inadequate immobilization
poor alignment
prolonged reduction time
infection
necrosis
elderly
immunosuppressed patient
severe bone trauma
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63
Q

treatments for delayed or non union

A

surgery- bone graft
electrical stimulation for osteocyte production
if infection- MD will debried, remove dead bone and hope it heals

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64
Q

RSD (reflex sympathetic dystrophy)

A

poorly understood condition.
causes problems with nerves and muscles has o do with sympathetic nervous system
neuropathic pain

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65
Q

signs and symptoms

A 
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
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66
Q

treatment

A

unknown

sometimes use nerve blocks to decrease pain but this doesn’t increase function

67
Q

pain management nursing care with ortho injuries

A

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
Q

Impaired physical mobility nursing care

A

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
Q

impaired tissue perfusion nursing care

A

some patients pay be admitted just for this reason
check 5Ps
look for pressure ulcers

70
Q

neurovascular compromise

A

circulation checks, cap refil, circulation (5Ps), swelling, reassess pain and sensation

71
Q

assessment of clients response to trauma

A

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
Q

health promotion r/t ortho injuries

A

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
Q

nursing dx for ortho injuries

A 
acute pain
risk for peripheral neurovascular dysfunction
risk for infection
impaired physical mobility 
risk for disturbed sensory perception
74
Q

home care: client teaching

A

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
Q

amputation

A

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
Q

Causes for amputation

A

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
Q

Underlying causes for amputation

A

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
Q

Goals with amputation

A

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
Q

site healing for amputations

A

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
Q

Complications with amputations

A

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
Q

repetitive use injuries

A

carpal tunnel syndrome

bursitis

82
Q

carpal tunnel syndrome

A

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
Q

bursitis

A

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
Q

meds for repetitive use injuries

A

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
Q

treatments for repetitive use injuries

A

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
Q

nursing diagnosis for repetitive use injuries

A

acute pain
impaired physical mobility
self care deficit

87
Q

Osteoarthritis discription

A

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
Q

risk factors for osteoarthritis

A

age, inherited, excess weight, inactivity, strenuous repetitive exercise, hormone factors.

89
Q

pathophysiology of osteoarthritis

A

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
Q

signs and symptoms of osteoarthritis

A 
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
Q

meds for osteoarthritis

A

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
Q

conservative treatment for osteoarthritis

A 
PT
Heat/Ice
Rest
Ambulation devices
Weight loss
Meds- analgesics and anti-inflammatory
93
Q

Surgery for osteoarthritis

A

knees and hips are the most common replaced- they get the most wear and tear

94
Q

complementary therapies for osteoarthritis

A

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
Q

nursing care for osteoarthritis

A

promote comfort- heating pads
maintain mobility-swimming
assist with adaption of lifestyle- OT consults

96
Q

nursing diagnosis for osteoarthritis

A

chronic pain
impaired physical mobility or limited mobility
self care deficit

97
Q

low back pain cause

A

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
Q

pathophysiology of low back pain

A

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
Q

radicular pain

A

seen with herniated disc, aggravated by movement, caused by pressure on nerve. very painful

100
Q

treatment for low back pain

A 
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
Q

Herniated disc definition

A

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
Q

most common sites of herniated disks

A

L 4-5
L5-S1
C5-6

103
Q

pathophysiology of herniated disks

A

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
Q

s/s of lumbar herniated disc

A

recurrent pain in lower back butt and legs, radiating pain Is called radicular pain
pt has weakness on affected side
foot drop
paresthesias

105
Q

s/s of cervical herniated disks

A 
pain in shoulder, arm, neck 
weakness 
weak hand grips 
parasthesia
muscle spasm
106
Q

Meds for herniated disks

A

analgesics NSAIDS muscle relaxers narcotics pain clinics

107
Q

muscle relaxers for herniated discs

A

robaxin
flexaril
valium
cause a lot of drowsiness

108
Q

treatment for herniated disk

A

conservative for 2-6 weeks
decrease activity
take medications
PT, massage, heat packs

109
Q

Laminectomy

A

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
Q

discectomy

A

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
Q

decompressive laminectomy

A

removal of bone from both sides of the spinous process
usually at 3 or 4 levels
decompresses pressure on spinal cord

112
Q

Spinal fusion

A

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
Q

spondylolisthesis

A

any forward slipping of one vertebra on the one below it

114
Q

spondylolysis

A

breaking down of vertebral structure

115
Q

Shingles

A

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
Q

Chicken pox vaccine

A

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
Q

People at risk for shingles

A 
usually effects people greater than 50 years of age, who are immunocompromised
chemo
elderly
have mono/cold/flu
immunity is decreased when stressed
118
Q

Signs and symptoms of shingles

A

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
Q

how long does shingles last?

A

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
Q

Treatment for shingles

A

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
Q

prevention of shingles

A

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
Q

nursing diagnosis for shingles

A

acute pain
disturbed sleep pattern
risk for infection

123
Q

Migraine headaches

A

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
Q

pathophysiology of migraines

A

abnormalities in cranial blood flow
brain activity
release of serotonin

125
Q

triggers for MHA

A

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
Q

Aura

A

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
Q

s/s of MHA

A 
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
Q

Abortive medications for MHA

A

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
Q

Prophylaxis or preventative meds

A

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
Q

nursing care for MHA

A

pain meds, room dark and quiet, education- regarding preventative meds and triggers, avoiding red wine, pay attention to diet

131
Q

Seizures definition

A

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
Q

idiopathic seizures

A

don’t know why they happen, can be genetic or developmental issues

133
Q

acquired seizures

A 
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
Q

prevention of seizures

A

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
Q

generalized seizures

A

pt loses consciousness

136
Q

tonic-clonic (grand mal) seizures

generalized

A

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
Q

absence (petit mal)

generalized

A

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
Q

partial seizures

A

does not affect the whole body

139
Q

simple partial seizures

A

one arm jerking, doesn’t necessarily lose consciousness, and can be aware of the jerking

140
Q

complex partial seizures

A

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
Q

status epilepticus

A

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
Q

occurrence of seizures

A

vary in frequency
absence- can happen 100x a day
tonic clonic- can happen every few weeks or once in a life time

143
Q

attacks can be precipitated by

A 
excitement
anger
menstruation
fatigue
some meds can lower seizure threshold 
brain tumors/scar tissue
144
Q

treatment during attacks

A

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
Q

nursing diagnosis for seizures

A

altered cerebral tissue perfusion
altered self image
low self esteem

146
Q

medications

A

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
Q

simple head injuries

A

meaning minor

minor head injuries loss of consciousness for a few minutes

148
Q

concussion

A 
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
Q

Closed Head Injury

A

can have skull fx with no brain injury and can have a brain injury with no skull fx

150
Q

contusion of the brain

A

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
Q

IICP increased intracranial pressure s/s

A

less and less responsive
BP with IICP widening pulse pressure
pupils start to dilate
IICP is not a simple head injury anymore

152
Q

epidural bleed

A 
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
Q

subdural bleed

A

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
Q

intracerebral bleed

A

bleed into brain tissue
cause trauma or high BP
abrupt onset- headach to unconscious
not safe to do surgery tight away

155
Q

trigeminal neuralgia

A

chronic disease of trigeminal nerve - caranial nerve 5
SEVERE FACIAL PAIN
Eye, cheeks, jaw
trigger zones

156
Q

meds for trigeminal neuralgia

A

tricyclic anticonvulsants- tegretol
Dilantin
Neurontin
muscle relaxants

157
Q

surgery for trigeminal neuralgia

A

rhizotomy- needle with electrocurrent

158
Q

Bells palsy

A

disorder of cranial nerve 7 resulting in paralysis of face

pain behind ear or jaw, onesided numbness, impaired taste

159
Q

meds for bells palsy

A

antiviral-acyclovir

anti-inflammatory- prednisone

160
Q

polyneuropathy

A

more than one area effected

simultaneous malfunction of many different nerves

161
Q

mononeuropathy

A

isolated peripheral neuropathy- affects a single nerve (carpal tunnel, shingles, leg falls asleep aka compression mononeuropathy.

162
Q

Visceral (autonomic) neuropathies

A

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
Q

meds for neuropathy

A

Neurontin, Lyrica, Cymbalta- most commonly used, capsaicin cream

NUR 103 (3 decks)

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