TEST #4 C. 37 Flashcards
1
Q
rosing sign
A
palpate on the left side and makes right side hurt
2
Q
mcburneys point
A
appendicitis starts periumbilical and goes down to RLQ
3
Q
rebound tenderness
A
press down and let go hurts; appendicits
4
Q
autonomic nervous system signs of g. barre
A
postural hypotension, arrhythmia, sweating, flushed face, urinary retention
5
Q
damaged myelin causes scar tissue and the scar tissue is called
A
sclerosis; multiple sclerosis
6
Q
wheres the phrenic nerve
A
c3-c5
7
Q
No problem with blood getting there but blood isn’t oxygenated
A
hypoxia
8
Q
A situation of greatly reduced or interrupted blood flow; Oxygen and glucose in that blood
A
ischemia
9
Q
Glutamate, the brain’s most prevalent excitatory amino acid neurotransmitter, is released in excessive quantities when blood vessels are blocked.
A
Excitatory amino acid injury
10
Q
Occurs with conditions that impair the function of the blood–brain barrier and allow transfer of water and proteins from the vascular into the interstitial space.
A
vasogenic edema
11
Q
an increase in intracellular fluid.
A
cytotoxic edema
12
Q
normal intracranial pressure
A
5-15 mm hg
13
Q
signs of intracranial pressure ; LATE SYMPTOMS
A
cushings triad
widening pulse pressure/hypertension
bradycardia-heart rate less than 60
irregular breathing
14
Q
Systolic going up and diastolic is going down
A
widening pulse pressure
15
Q
differentiate between cushings and shock state
A
SHOCK
decrease bp
increase pulse
increase respirations
CUSHINGS
increase bp
decrease pulse
decrease respirations
16
Q
cerebral perfusion pressure in the brain is normally
A
70-100
17
Q
the most common herniation syndrome.
A
uncal syndrome / transtentorial
18
Q
upward herniation; less frequent
A
infratentorial herination
19
Q
downward herniation
A
posturing
20
Q
bruising on the brain surface or a lacerations or tearing of brain tissue.
A
contusions
21
Q
basilar skull fractures 2 signs
A
raccoons eyes-indicative of brain injury
battle sign-bruising behind ear
22
Q
tear in the artery
A
epidural hematoma
23
Q
develops between the inner side of the skull and the dura.
A
epidural hematoma
24
Q
a history of head injury and a brief period of unconsciousness followed by a lucid period in which consciousness is regained.
A
epidural hematoma
25
whats worse epidural or subdural
epidural because its a tear in the artery and veins bleed slower so youd want that
26
develops in the area between the dura and the arachnoid (sub-dural space)
subdural hematoma
27
subdural they can stay away from the hospital. why
slower bleed because its a vein, and in elderly the brain shrinks so more room for blood
28
a&o x4
alert and oriented to person place time and date
29
level of consciousness LOOK UP
confusion
delirium-restlessness, illusions, and incoherence of thought and speech.
obtundation-the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states
stupor-only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state
coma-state of unarousable unresponsiveness.
30
measures of loss of consciousness
glasglow coma scale measures motor response, verbal response, and eyes (pupil)
31
total score of glasglow coma
15- best response
8 or less- comatose
3-dead
32
doll eyes
when you turn their head the eyes will stay midline -not good (comatose patient)
33
they will have period of aspirations
cheyne stokes breathing
34
respiratory response in brain injury early and late
yawning is early
| cheynes stokes breathing is late
35
when somebody is having a stroke its usually
in circle of willis
36
syndrome of acute focal neurologic deficit resulting from a vascular induced disorder that injures brain tissue
stroke; cva; brain attack
37
most common
| Interruption of blood flow; blockage; no bleeding
ischemic stroke
38
less common
| More fatal ; have a bleed; must stop bleeding
hemorrhagic
39
2 types of ischemic strokes
embolic - clot that moves
| thrombotic -clot that was formed there
40
```
Hypertension
Smoking
Diabetes
Diet
Physical inactivity
Obesity
High blood cholesterol
Carotid Artery Disease
Peripheral Artery Disease
Atrial Fibrillation
Sickle cell disease
```
risk factors you can control
41
```
Age
Family history
Race
Gender
Prior Stroke, TIA or Heart Attack
```
risk factors you cannot control
42
“ministroke” is equivalent to “brain angina” and reflects a temporary disturbance in cerebral blood flow, which reverses before infarction occurs, analogous to angina in relation to heart attack.
Transient ischemic attack-
43
common predisposition for a embolic stroke
deep vein thrombosis
44
common predisposition for a hemorrhagic stroke
advancing age and hypertension
45
Most frequently fatal stroke is caused by the spontaneous rupture of an intracerebral vessel
hem stroke
46
post stroke fast
facial drooping
arm drift
speech difficulties
time
47
headache, fever, and stiffness of the neck (nuchal rigidity).
bacterial meningitis
48
what causes bacterial meningitis
pneumococcal and meningococcal.
49
infection of the brain that looks the same as meningitis but they will get more neuro signs; confusion
encephalitis
50
stages of a seizure
aura- alterations in smell, taste, visual perception, hearing, and emotional state
ictus- actual seizure
postictal - alert but very sleepy because of the increased energy, oxygen, a seizure utilizes.
51
unconsciousness along with both tonic and clonic muscle contractions.
tonic clonic seizures
52
see Neurofibrillary tangles Neuritic plaques on the scans
alzheimers
53
previously called picks disease but there are changes in behavior and problem with language
Frontotemporal Dementia (FTD)
54
Is an acute state of brain dysfunction.
Onset is usually abrupt.
Autonomic nervous system is overactive.
Is common in critical care units, postsurgically, or during withdrawal from CNS depressants (e.g., alcohol, narcotics).
delirium
55
the progressive failure of many cerebral functions.
Onset is usually gradual.
Progressive dementias produce nerve cell degeneration and brain atrophy.
Age is the greatest risk factor.
dementia
56
type of brain disorder caused by a lack of vitamin B-12, or thiamine.
Wernicke-Korsakoff syndrome
57
Rare, autosomal dominant hereditary-degenerative disorder; short arm on chromosome 4
hunington disease
58
what is another name for huntingtons disease and where does it affect
chorea; basal ganglia
59
originate in the target gland responsible for producing the hormone.
primary disorders of endocrine
60
the target gland is essentially normal, but its function is altered by defective levels of stimulating hormones or releasing hormones from the pituitary gland.
secondary disorders of endocrine
61
results from hypothalamic dysfunction… both the pituitary and target glands are under stimulated.
tertiary disorders of endocrine
62
most common cause of hyperpituitarism
pituitary adenoma, or a benign tumor arising from the anterior pituitary*
63
Exaggerated growth of the ends of extremities (fingers, hands, toes, and feet)
acromegaly
64
most common cause of acromegaly
Growth hormone secreting adenomas
65
```
Exaggerated growth of the ends of the extremities (fingers, hands, and toes)
Broad and bulbous nose
Protruding jaw
Slanting forehead
difficulty swallowing
Kyphosis (hunchback)
sleep apnea
```
acromegaly
66
Acromegaly is commonly caused by: (select all that apply)
adenomas -tumor
| excessive secretion of growth hormones
67
A child’s body begins changing into that of an adult (puberty) too soon.
Early activation of hypothalamic-pituitary-gonadal gland
precocious puberty
68
How do we diagnose precocious puberty?
Physical exam
Blood test
Ultrasound
69
function of the thyroid gland
take in iodine and convert it into t3 and t4; Combine iodine and the amino acid tyrosine to make T3 and T4.
70
when thyroid hormones t3 and t4 drop too low..
pituitary gland responds to make thyroid stimulating hormone - product the hormones
71
p. 778
32.1
72
two tests to do for meningitis
Kernig and Brudzinski
73
abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest. herniation in brain
decorticate posture
74
abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward.
decerebate posture
75
inability to synthesize the thyroid hormone, or the deficiency of the thyroid stimulating hormone (TSH) secretion.
congenital hypothyroidism
76
why does congenital hypothyroidism happen
defect in thyroid anatomy
iodine deficient-not permanent
error in mechanism
77
manifestations of congenital hypothyroidism
prolonged jaundice
Respiratory and feeding difficulties
somonlence
78
manifestations of congenital hypothyroidism if it is left untreated.
creatinism -teeth delayed, mental retardation, impaired physical growth
79
regulates metabolism
t4
80
Health condition where the thyroid is not producing enough hormones, resulting in a slowed metabolic rate
acquired hypothyroidism
81
common cause of acquired hypothyroidism
Hashimoto thyroiditis: autoimmune disorder where the thyroid gland is destroyed by the immune system
82
Onset of Hashimoto
will see goiter before hypothyroidism is evident
83
```
Extreme fatigue *
Cold intolerance*
Weight gain despite appetite loss*
Puffy face*
dry skin
constipation
hoarse voice
```
acquired hypothyroidism
84
Life-threatening condition caused by Hypothyroidism
Myxedematous Coma
85
Myxedematous Coma triad
hypothermia
fluid and electrolyte imbalance
co2 retention and hypoxemia
86
```
A 20-year-old woman presents to the clinic with signs of peripheral edema, short stature, cold intolerance, weight gain, and her mother notices she is having trouble concentrating on her school work. She reports having heavier than normal menstrual cycles over the last few months. What diagnosis would the nurse suspect?
A: Precocious Puberty
B: Congenital Hypothyroidism
C: Hyperthyroidism
D: Acquired Hypothyroidism
```
acquired hypothyroidism
87
most common cause of hyperthyroidism
graves disease and diffuse goiter
88
normal sinus rhythm
1. is it regular?
2. identify the rate-count the r waves X by 10 to get the heart rate
3. is there a p for every QRS
4. QRS wide or narrow?
5. PR interval is less than .20
89
irregularly irregular
| no P waves
atrial fib
90
drug to put patient on in atrial fib
anticoagulant so that can't form clots
91
racing heart
shortness of breath
light headed
symptoms of atrial fib
92
protruding eyes
Ophthalmopathy
93
manifestations of graves disease
hyperthyroidism, ophthalmopathy, goiter
94
most common type of hyperthyroidism
graves disease
95
Extremely rare form of thyrotoxicosis (excess thyroid hormone in the body)
thyroid storm
96
```
Tachycardia
Fever (105-106 F)
Persistent sweating
Nausea & Vomiting
Confusion
Agitation
Restlessness
Diarrhea
Unconsciousness
```
thyroid storm- fever is #1
97
PaCO2
35-45 respiratory
98
HCO3
22-26 metabolic
99
which one is flipped from the rest on ABGs
PaCO2 lower numbers are alk and higher are acid
100
A disease characterized by an insufficiency of all hormones produced by the adrenal cortex
addison disease
101
```
Hyperpigmentation
Hypoglycemia
Weight loss
Hyponatremia
Hyperkalemia
Results in dehydration, weakness, and fatigue
```
addison disease
102
Mrs. Jones presents to the ER with dehydration, weakness, and fatigue. She was diagnosed with Addson Disease. The nurse knows to watch for which lab values? (Select all that apply)
hyperkalemia
| hyponatremia
103
hypercortisolism from any cause
cushings syndrome
104
```
buffalo hump
osteoporosis
weight gain
high blood pressure
pink and purple stretch marks
round face
copper tone
```
cushing syndrome
105
```
Mrs. Jones arrives at the clinic presenting with muscle weakness, thinning of the extremities, and purple striae over her abdomen. Based on these clinical manifestations, you suspect her body may be producing excess amounts of cortisol. As a good clinician, which test would you perform to support this diagnosis? Select all that apply.
A. Saliva test
B. Tensilon test
C. 24-hour urine test
D. BUN test
```
AC
106
Addison's disease, a condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs.
addisons
107
A life-threatening condition that occurs when there is not enough cortisol being produced
acute adrenal crisis
108
causes the adrenal gland to release cortisol
ACTH
109
if the pituitary gland is injured then what could happen
the reduction of ACTH and therefore reduction of cortisol
110
hypotension
shock
abnormal craving of salt
are the hallmark signs
acute adrenal crisis
111
```
A patient with known Addison disease presents to the ER after an MVA with nausea, vomiting, hypotension, abdominal pain, and shock. As a nurse, you suspect:
Cushing syndrome
Acute adrenal crisis
Thyroid storm
Myxedematous coma
```
acute adrenal crisis
112
all shocks has signs of
hypoeperfusion on cellular level
113
Used to diagnose hyperthyroidism or determine severity of hyperthyroidism
t3; elevated levels indicate hyperthyroidism
114
determines how thyroid is functioning
thyroid stimulating hormone
115
when TSH levels are elevated
t3 and t4 are decreased ; hypothyroidism. low levels of tsh and high levels of t3 t4 is hyperthyroidism
116
thyroid absorbs iodine from the blood to product
t3 and t4
117
radioactive iodine uptake test
measures how much iodine is in the thyroid
118
Blood levels
24-Hour Urine Cortisol Test
ACTH Stimulation Test
Insulin-Induced Hypoglycemia Test
adrenal function tests
119
An increase in ACTH from the pituitary will cause in increase in which hormone?
Cortisol
| -example of a glucocorticoid released from the adrenal CORTEX
120
people with metabolic syndrome are usually what shape
apple
121
metabolic syndrome
```
waist >35 in women >40 in men
triglycerides >150
high density lipoproteins <50 women or <40 men
bp >130/85
fasting plasma >100
```
122
A state of continuous seizures lasting more than 5 minutes, or second seizure is experienced before the person has fully regained consciousness from the preceding seizure, or a single seizure lasts longer than 30 minutes.
status epileptics
123
potential complication of status epileptics
respiratory status is compromised so they are concerned about air maintenance
124
hallmark signs of intracranial pressure
headache and papillary edema
125
Rare group involve neurons-control VOLUNTARY muscle movement
Amyotrophic Lateral Sclerosis
126
who had als
lou gehrig and steven hawkings
127
what signs can be elicited by bacterial meningitis
kernigs
| brudzinski
128
Normal activity of the spinal cord ceases at and below the level of injury; sites lack continuous nervous discharges from the brain
spinal shock
129
5 a's of alzheimers
amnesia- memory loss
aphasia- loss of speech
agnosia- can't recognize things
apraxia- misuse of objects; using shoe for pen
anomia- inability to remember names of things
130
whats the problem in myasthenic crisis
bulbar muscles -respiratory muscles -become weak which can lead to artifical airway
131
cause of acromegaly
Growth hormone secreting adenomas
