Test 4 Content Flashcards
What is the pathology behind Guillan-Barre?
Immune system attacks parts of the peripheral NS that involves ascending paralysis. This presents as progressive motor weakness
Which vaccinations should you hold if a patient has had Guillian-Barre in the past 6 weeks?
Flu
Tdap
DTAP
What are the complications of Guillian-Barre?
Acute Respiratory Failure that requires mechanical ventilation
Respiratory Acidosis
What is the pathology behind Myasthenia Gravis?
Acquired autoimmune disease in which antibodies attach to Ach Receptors (primary are at neuromuscular junction and at motor end plate). This decreases the amount of nerve impulses at NMJ and therefor skeletal muscle is unable to be stimulated)
What are the hallmark characteristics of Myasthenia Gravis?
Progressive muscle weakness that improves with rest
Generalized ocular palsies
Weak or incompetent eye closures
Drooping eyelid
Diplopia
What are the symptoms of an undermedicated Myathenia Gravis Crisis?
Respiratory Distress
Increased HR/BP
Poor/weak cough
Dysphagia/aspiration
Bowel/Bladder control
What are the examples of a cholinergic crisis?
Abdominal cramps
N/V/D
Excessive secretions
Miosis/blurred vision
Hypotension
Fasciculations
Weakness
What is the pathology of Multiple Sclerosis?
Autoimmune chronic disease that involves demyelination of axons that impairs nerve impulses leading to lesions and axonal injury
What are the 4 cardinal signs of Parkinsons?
Tremor (one sided on hand or leg)
Rigidity (resistance/rigidity to passive movement)
Akinesia/Bradykinesia
Postural instability
What are the main complications of PD and Alzheimers?
Falls
Aspiration pneumonia
Impaired coping
Impaired cognition
What is a tonic seizure?
Stiffening, rigidity of muscles, loss of consiousnes
What is a clonic seizure?
Rythmic jerking of extremities, breathing irregularities, airway compromise, incontinence, postictal confusion, decreased LOC
Repetitive widespread movements
What is an Absence seizure?
Periods of staring and loss of awareness
What is a myoclonic seizure?
Sudden, uncontrolled jerking movements of one or more muscle groups and will not have LOC
NOT widespread
What is an Atonic Seizure?
Sudden loss of msucle tone/strength but usually remains conscious and can be called drop attacks (sudden loss of muscle tone and strength)
What is a focal/local seizure?
No LOC
+ Aura
Unusual unilateral sensation/movement
ANS sx
What is a complex/partial seizure?
Altered level of consiousness with unsual repetitive movements that can become a tonic clonic seizure
What is the nursing priority in the seizure postictal period?
Roll to side and and ensure airway is open
What should be recorded by the nurse during a seizure?
Record the onset, duration, LOC, apnea, cyanosis, motor activity, incontinence
What is the prediabetic and diabetic HA1C levels?
Prediabetes: 5.4-6.4%
Diabetes: >6.5
What is the oral glucose tolerance test?
When they take 75 g of glucose and then recheck after 2 hours
Positive if >200 after 2 hr
What is the somogyi phenomenon?
Morning hyperglycemia from the counter regulatory response to nightime hypoglycemia
What is the intervention to the somogyi phenomenon?
Adequate evening and nighttime intake of food, evaluation of insulin dosage
(A protein rich snack can prevent this)
What is the dawn phenomenon?
Nightime release of growth hormone
Elevation of BG between 0300 & 0600
What is the intervention to the dawn phenomenon?
Increase insulin at night
What is the pathology behind hyperglycemic hyperosmolar syndrome?
More common in type 2, insulin deficiency=profound hyperglycemia, dehydration and electrolyte imbalance
How do you treat mild hypoglycemia?
10 to 15g of rapidly absorbed carbohydrates/glucose tabs , check BG in 15 then eat a small meal with protien
How do you treat moderate hypoglycemia?
15 to 30g of rapidly absorbed carbohydrates (D50 ampule IVP), small meal in 15 to 30 minutes with protein, BG in 15 and continue to monitor
How do you treat severe hypoglycemia?
Glucagon 1mg IM or SQ
2nd dose if patient remains unconscious
Once resolved eat a small meal with protein
Unresolved-transport to ED/Call RT
What type of fluids should be administered for DKA?
hypotonic fluids 0.9NS
Which electrolyte is used to stablize the cell membrane in DKA?
Calcium
What are the insulin administration guidelines in DKA?
0.1unit/kg/hr
Infusion 0.1unit/kg/hr with a goal of decreasing glucose by 75 mg/dL.hr
What are the insuloin administration guidelines for HHS?
Insulin AFTER fluid rescuitation
Bolus 0.1 unit/kg
Infusion 01.unit.kg.hr with a decrease in glucose by 50-75mg/dL/hr
What are the fluid rescutation guidelines for HHS?
Replace wwith NA @ 1L/hr until BP and UO are stabilized and then switch to 1/2NS
What is the testing for diabetic neuropathy?
Monofilament testing q6 months-1yr in very specific places on foot where monofilaments are placed.
8-10 locations felt=normal
<8=impaired
What are the SSAs for cataracts?
-Blurred vision
-Cloudiness
-Decreased color perception
-Reduced night vision
-Diplopia with present opacities on inspection
-Absent red reflex on exam
What are the pre and post operative medications for catarcts?
Pre: Atropine
Post: Antibiotics and steroids
What are the SSAs for open angle glaucoma?
Foggy Vision
HA
Halos
Decreased peripheral vision with increased IOP
Cupping/atrophy of optic disc
What are the SSAs for closed angle glaucoma?
Severe pain radiating to face
N/V
HA
Halos
Blurred vision
Photophobia
Decreased light perception w/reddened sclera
Non reactive pupil
Decreased visual acuity on Snellen Chart
Decreased peripheral vision
Rapid increase on IOP
Cloudy aqueous humor
Shallow anterior chamber
What are the SSAs for macular degeneration?
Blurring
Distortion
Loss of central vision
Loss of depth perception
Decreased vision on Snellen
What are the dietary treatment options for dry macular degeneration?
High antioxidants
Carotene
Vitamin E
B12
What are the treatment options for wet macular degeneration?
Laser to seal leaking vessels or injections to inhibit blood vessel growth
What are the SSAs for a detached retina?
Painless
Bright flashes of light
Floaters with gray bulges/folds on retina
What are the Interventions for a retinal tear?
Cryotherapy
Photocoagulation
Diathermy
Which medications should be avoided when a patient is experiencing prebycusis?
Gentamycin/Vancomycin
Furosemide
NSAIDS (ibuprofen)
Cisplatin (Chemo agent)
What is the pathology behind Meniere’s Disease?
Swelling distorts the semicircular canals, cochlea and causes a backup of fluid in the end-lymphatic sac
What are the SSAs for Meniere’s Disease?
Episodic tinnitus
N/V
Vertigo with 1 sided sensorineural loss
Impaired balance
What are the interventions for Meniere’s Disease?
Nutrition
Vestibular rehab therapy
Surgery (to decompress the end lymphatic sac)
Meds (duiretics, antivertiginous, antimeticsm benzos)
What is Labrythitis?
Inflammation of the inner ear
What are the SSAs of Guillian Barre?
Acute illness (URI, GI, flu, strep)
HIV
Surgery
Virus (CMV, Epstein Barr, Varicella Zoster)
Lupus
medications
Vaccines
How is Guillian Barre Diagnosed?
CBC (for increased WBC)
Lumbar puncture (looking for increased protein in CFS)
Electromyogram (muscle response to electrical stimuli)
MRI
CT
What are the diagnostic criteria for Myasthenia Gravis?
Thyroid Function Test
Serum protein electrophoresis
ACH receptor antibodies
Repetitive nerve stimulation
Electromyography
Single fiber EMG
