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Adult-Geron Nursing II > Unit 3 > Flashcards

Unit 3 Flashcards

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1
Q

Bacterial Meningitis Subjective Signs

A 
Headache
Photophobia
Neck Pain/Stiffness
Stiffness (Nuchal)
N/V
Myalgia
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2
Q

Bacterial Meningitis - Objective Symptoms

A

Fever (103+) w/chills, tachycardia, & tachypnea
Brudzinski’s sign
Kernig’s sign
Opisthotonus
Change in mental status (confusion, lethargy, stupor, coma)
Cranial nerve dysfunction (unilateral) ->diploplia, facial weakness, pupillary abnormalities
Seizures
Rash (petechial)
Posturing (decorticate/decerebrate)

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3
Q

Kernig’s Sign

A

Inability to fully extend the legs

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4
Q

Brudzinski’s Sign

A

Hip & knee flexion when the neck is flexed

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5
Q

Opisthotonus

A

Severe back spasm, causing arching of the back

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6
Q

Bacterial Meningitis causes cranial nerve abnormalities (unilateral). What are the symptoms?

A

diploplia, facial weakness, pupillary abnormalities (dilated/nonreactive)

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7
Q

Post-polio - Subjective Signs

A 
Muscle weakness (progressive)
Fatigue (generalized & muscular)
Joint pain
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8
Q

Post-polio - Objective Symptoms

A 
Muscle atrophy (gradual)
Increasing skeletal deformities (scoliosis-curvature of the spine)
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9
Q

Who is risk for Post-Polio Syndrome

A

Polio is a contagious (viral) disease. Only a polio survivor can develop Post-Polio Syndrome. An estimated 25-40% of polio survivors develop PPS.

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10
Q

What causes Post-Polio Syndrome

A

The new weakness appears to be related to the degeneration of individual nerve terminals and the muscle fibers it activates. Body compensates by creating new nerve-end terminals. Over time motor neurons lose the ability to maintain the increased work demands.

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11
Q

How is Post-Polio Syndrome diagnosed

A

Diagnosed after a comprehensive medical history & physical exam, and by excluding other disorders. No specific labs

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12
Q

Criteria for a Post-Polio diagnosis

A

[] Prior paralytic poliomyelitis (w/motor neuron loss)
[] A period of partial or complete functional recovery after acute infection. (15+ years)
[] Slow progressive & persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle/joint pain
[] Symptoms persist at least 1 year
[] Exclude other causes (neuromuscular, medical, or skeletal abnormalities)

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13
Q

True or False:
Progressive scoliosis causing breathing insufficiency can occur years after polio but is not an indicator of Post-Polio Syndrome

A

True

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14
Q

How is Post-Polio Syndrome treated

A

[] No effective Rx that can stop deterioration or reverse the deficits.
[] Non-fatiguing exercises may improve muscle strength & reduce tiredness.

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15
Q

What is the role of exercise in the treatment of Post-Polio Syndrome

A

[] Exercise is safe & effective (medical supervision.
[] More likely to benefit those muscle groups that were least affected by polio.
[] Cardio better than strengthening
[] Frequent breaks
[] No muscle should be exercised to the point of ache, fatigue, or weakness

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16
Q

Can Post-Polio Syndrome be prevented

A

No

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17
Q

How is Progressive Supranuclear Palsy (PSP) different from Parkinson’s Disease

A

PSP:
[] Usually stand straight or occasionally tilt their heads backward.
[] Speech & swallowing problems are more severe and present earlier in disease process.
[] Abnormal eye movements
[] Tremor rare
[] Respond poorly to levodopa

Parkinson's:
[] Usually bend forward
[] Normal eye movements
[] Tremor common
[] Respond will to levodopa
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18
Q

How is Progressive Supranuclear Palsy (PSP) similar from Parkinson’s Disease

A

[] Both PSP & Parkinson’s cause stiffness, movement difficulties, & clumsiness.
[] Age of onset: late middle age
[] Bradykinesia (slow movement)
[] Muscle rigidity

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19
Q

Most common neurodegenerative disease

A

Alzheimer’s Disease

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20
Q

Second most common neurodegenerative disease

A

Parkinson’s Disease

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21
Q

Parkinson’s Disease - general definition

A

Chronic, progressive, degenerative disorder of the basal ganglia in the CNS

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22
Q

Parkinsonism is divided into 4 categories

A

[] Idiopathic (most common)
[] Symptomatic
[] Parkinson-plus syndromes (known cause, ie CVA, drugs, infection, trauma, toxin exposure)
[] Other herododegenerative diseases (ie Huntington’s)

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23
Q

Cause of Parkinson’s Disease

A

Unknown

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24
Q

Pathophysiology of Parkinson’s Disease

A

[] A degenerative disease of the motor systems of the brain.
[] Progressive cell loss is noted in the substantia nigra, which carry major connections to the basal ganglia.
[] Also kills dopaminergic neurons, noradrenergic neurons, & cholingergic neurons. This produces a cellular abnormality called Lewy Bodies inside the neurons.

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25
Q

Parkinson’s Disease - Subjective Signs

A 
6 cardinal signs:
 [] tremor at rest
 [] rigidity
 [] bradykinesia or hypokinesia
 [] flexed posture
 [] loss of postural reflexes
 [] freezing phenomenon
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26
Q

Parkinson’s Disease - Objective Symptoms

A

[] tremor
[] weak & clumsy limb
[] a stiff, achy limb
[] gait disorder

Constipation, orthostatic hypotension, dysarthria (slurred speech), hypophonia (soft speech), hypomimia (mask-like face) are also common.

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27
Q

Parkinson’s Disease - Diagnostic Tests

A

H&P usually leads to diagnosis
CT or MRI to r/o structural brain lesions
Ca2+ level to exclude hypoparathyroidism
PET scan can detect changes in striatal dopamine & subclinical nigral pathology

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28
Q

Parkinson’s Disease - Management

A 
Control symptoms
Levodopa 
Add Seleginine (MAO-B inhibitor) if Levodopa produces fluctuation in response
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29
Q

Parkinson’s Disease - Differential diagnosis

A 
Essential tremor
Medication induced
Infarct or tumor of the basal ganglia
Wilson's disease 
Huntington's disease
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30
Q

Parkinson’s disease - Differential Dx

A 
Essential tremor
Medication induced
Progressive Supranuclear Palsy
Infarcts or tumors in the basal ganglia
Wilson's disease
Huntington's disease
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31
Q

Levodopa. Drug class = ________

A

Dopaminergic

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32
Q

Drug class = MAO Inhibitor
Name 2 examples
Used to treat ________

A

Selegiline (Eldepryl L-deprenyl)
Rosagiline (Azilect)

Parkinson’s disease

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33
Q

Drug class = Dopaminergic

Used to treat _________
2 examples

A

Parkinson’s disease

Carbidopa/Levodopa (Sinemet, Atamet)
Amantadine (Symmetrel)

34
Q

Drug class = Dopamine Agonist

4 examples
Used to treat _______

A

Bromocriptine (Parlodel)
Pergolide (Permax)
Pramipexole (Mirapex)
Ropinirole (Requip)

Parkinson’s disease

35
Q

Drug class = Anticholinergics

2 examples
Used to treat _______

A

Trihexyphenidyl (Artane)
Benzotropine (Cogentin)

Parkinson’s disease

36
Q

Drug class = Peripheral catechol-O-methyltransferase (COMT) Inhibitors

2 examples

Used as adjunctive therapies to ______ for the treatment of ______

A

Tolcapone (Tasmar)
Entacapone (Comtan)

Adjunctive therapy to levodopa for the treatment of Parkinson’s disease.

37
Q

Parkinson’s disease - Treatment options for patients with severe symptoms that are refractory to meds.

A

Thalamotomy (for intractable tremors and drug induced kinesias
Pallidotomy (for bradykinesias, tremor, and dyskinesias
Deep brain stimulation to suppress rest tremor

38
Q

Stroke - Differential diagnosis

A

[] Subarachnoid hemorrhage (severe HA w/ \/ LOC
[] Subdural hematoma (HA-generalized & bitemporal
[] Brain abscess (HA, altered LOC, hemiparesis, NV, fever)
[] Idiopathic intracranial HTN (pseudotumor) (papilledema, diplopia, HA, normal CT)
[] Arterial dissection (cephalic pain, sudden HA ->retinal or hemispheric ischemic symptoms)
[] Carotid dissection (Occipital HA or acute neck pain -> ischemic symptoms of diplopia, syncope, and amaurosis fugax, unilateral neck pain that is sudden and radiates to the ipsilateral face or eye)
[] Encephalitis (general, sudden HA w/ confusion, altered LOC, seizures)

39
Q

Amaurosis Fugax

A

A temporary blindness that may result from transient ischemia caused by an insufficiency of the carotid artery or exposure to centrifugal force

40
Q

Mini-mental exam - definition

When is it used

A

Tool to assess mental status or cognition.

Useful for gross screening of dementia. It is the initial test done when trying to diagnose Alzheimer’s Disease.

41
Q

Agitation Dementia - Non-Pharm Management

A 
Reduce 5 common triggers:
 fatigue
 change in routine
 Misleading or inappropriate stimulus
 Demands to perform beyond abilities
 Physical stressors (pain)
Meaningful activities
Validation therapy
Social contract
Animal0assisted behavior
Exercise, Reminiscence,
Music
Relaxation
42
Q

Agitation Dementia - Pharm Management

A

Atypical antipsychotics (1st line) Quetiapine (Seroquel)
Anticonvulsants and acetylcholinesterase inhibitors (2nd line)
Benzodiazepines

43
Q

Suicide Stats

A

Males successfully complete suicide (gun) 3:1 vs. females (OD).
Risk /\ w/age; 65+ more likely to commit suicide.
Older adults are less likely to voice intent
Caucasians are at the greatest risk
Higher risk: unemployed, single, divorced, widowed, EtOH/drug problems, Chronic/life-threatening/painful illness.
Chronic alcoholism & substance abuse = 25% of all completed suicides
Major depression and bipolar disorders = 50% al all suicides.
White men with mild depressive disorder are 5X more likely to commit suicide than the general pop.

44
Q

Know causes of bacterial meningitis.

What age group at risk

A 
Neisseria meningitis (children/young adults)
Heamophilus influenza type B (infants/children)
Streptococcus pneumonia (adults)
45
Q

Screening tools for chemical dependency

A

CAGE
TACE (alcoholism in pregnant woman)
CRAFFT(adolescent alcohol problem)

46
Q

C
A
G
E

A

Alcohol use assessment:

Have you ever tried to Cut back?
Have you ever been Annoyed/Angered when questioned about use?
Have you ever felt Guilt about use?
Have you ever had an Eye-opener to get started in the AM?

47
Q

T
A
C
E

A

How many drinks does it Take to make you feel high?
Have people Annoyed you by criticizing your drinking?
Have you felt you ought to Cut down on your drinking?
Have you ever had to have an Eye-opener?

48
Q 
C
R
A
F
F
T
A

Have you ever ridden in a Car w/someone high/drunk?
Do you drink/take drugs to Relax, feel better about yourself, or to fit it?
Do you drink/take drugs while you are Alone?
Do you ever Forget things you did while drinking/taking drugs?
Does a Family member or Friend tell you to cut down?
Have you ever gotten into Trouble because of drinking/drugs?

49
Q

Stress Incontinence - management

A 
Kegel exercises
Weight loss
Electrical stimulation
Alpha-adrenergics agonists ( )
No diuretics
Surgical correction of hypermobile bladder neck & periurethral bulking agents
50
Q

Urge incontinence - management

A 
Scheduled toileting
Fluid management
Treat UTI if needed
Topical estrogen
Anticholinergics
Smooth muscle relaxants
Tricyclic antidepressant 
Sx-stones, tumors
OAB-antimuscarinics to block parasympathetic stimulation of detrusor muscle
51
Q

Overflow incontinence - Management

A 
Tx underlying problem
Scheduled toileting
Crede's maneuver
Alpha-blockers
Catheters/pads
52
Q

Functional incontinence - Management

A 
Remove barriers
Education
Scheduled toileting
PT/OT
Vaginal cone
Kegel exercises
Pads
53
Q

Rx - overactive bladder

A 
Anticholinergics
 Oxybutynin (Ditropan)
 Tolterodine (Detrol)
 Trospium chloride
 Darifenacin
 Solifenacin
 Fesoterodine fumarate (Toviaz)
54
Q

What can cause “the worst headache of my life”

A

*Traction/Inflammatory headache
Temporal arteritis
Subdural hematoma

Immediate referral to neurosurgeon

55
Q

Describe a traction/inflammatory

A 
Acute
New onset
Increasing intensity
Medical emergency
Constant progressive pain
56
Q

TIA treatment

A

Hospitalization should be considered for patients seen within 72 hours of the attack, when they are at increased risk for early recurrence

57
Q

Most common drugs that cause delirium

A 
Tricyclic antidepressants
Lithium
Sedative hypnotics (benzos)
Anticonvulsants (barbiturates)
Anti-Parkinson's (benztropine, trihexyphenidyl)
Narcotics
Anticholinergics 
Beta blockers
Steroids
NSAIDs
Digoxin
Cimetidine
Fluoroquinolones
Skeletal muscle relaxants
58
Q

Potential causes of new onset seizures

A 
In most newly diagnosed cases, no specific cause is identified.
Many implicating factors:
 Head trauma
 CNS infection
 CVA
 Hyponatremia
 Hypocalcemia
 Hypoglycemia
 Hypoxia
 Drug OD/withdrawal
59
Q

New onset seizures - testing that should be done

A 
CBC 
Glucose
CMP
LFTs
Serum Ca2+
UA
Drug screen
Blood alcohol
Blood levels of anti-seizure meds
EEG
CT
MRI
lumbar puncture
EKG
60
Q

Dementia associated with Parkinson’s disease

Pathophysiology

A

Degenerative disorder of the basal ganglia involving the Dopaminergic nigrostriatal pathway. It involves the loss of pigmented neurons in the substantia nigra -> Formation of Lewy bodies

61
Q

Parkinson’s disease dementia may affect multiple cognitive domains including:

A 
Attention
Memory
Visuospatial
Constructional
Executive functions
62
Q

How to handle confusion in a NH patient who has a psych diagnosis.

A

Treatment consists of
identifying the underlying cause,
correction of precipitating factors, &
symptom mgmt.

63
Q

Interventions for the confused NH pt.

A 
Restore fluid and electrolyte balance
Environmental changes
Support techniques (ie eliminate unnecessary stimuli, safe environment, reduce anxiety)
64
Q

If the underlying cause of confusion (in the NH pt.) is a psych diagnosis ___________ may be helpful.

A

Pharmacotherapy such as sedatives and neuroleptics.

65
Q

Drugs prescribed for delirium

A 
Haloperidol
Thioridazine
Chlorpromazine
Ativan
Midazolam
Risperidone
Zyprexa
66
Q

Early symptoms of Alzheimer’s Disease

A 
Difficulty remembering names and recent events
Difficulty expressing oneself with words
Spatial cognition problems
Impaired reasoning and judgment
Apathy
Depression
67
Q

Later symptoms of Alzheimer’s Disease

A

Impaired judgment
Disorientation
Behavior changes
Difficulty speaking, swallowing, walking

68
Q

Management of Alzheimer’s Disease

A

First line of treatment: Cholinesterase inhibitors

ie: Donepezil, Galantamine, & Rivastigmine

69
Q

Dementia with Lewy Bodies - common symptoms

A

Visual hallucination
Muscle rigidity
Tremors

70
Q

Dementia with Lewy Bodies - Management

A

Avoid neuroleptic drugs
Social interaction
Daily exercise
Low dose atypical antipsychotic (Quetiapine)

71
Q

Frontotemporal dementia - Symptoms

A

Change in personality and behavior and difficulty with language.

72
Q

Pick’s disease is characterized by Pick’s bodies in the brain. It is a form of _____

A

Frontotemporal dementia

73
Q

Normal pressure hydrocephalus - Symptoms

A

Difficulty walking (ataxic gait)
Memory loss
Incontinence

74
Q

Chronic Rx Management of Dementia

A 
Rivastigmine
L-dopa
Selective serotonin reuptake (depression)
Clonazepam or melatonin (sleep)
Midodrine
Memantine (hallucination or delusions)
75
Q

Potential causes of seizures

A 
Head trauma
Tumors or lesions
Alzheimer's Dis.
CNS infection
CVA
Atherosclerosis
Parkinson's Dis.
Intracranial Hemorrhage
Metabolic Disorders
Substance withdrawl
76
Q

Characteristics of Essential Tremor

A

Enhanced by emotional stress
Bilateral, begins in fingers and hands
Spreads to jaws, lips, & head

77
Q

Treatment of Essential Tremor

A

Often unnecessary
If tremor is disabling, then propranolol
Primidone, if propranolol is ineffective
If Rx’s are not effective, then high frequency thalamic stimulation or subdural motor cortex stimulation

78
Q

Cerebellar tremor occurs during…

A

movement and increases toward the end of purposeful act.

79
Q

Cerebellar tremor - Associated s/s

A 
Ataxia
Nystagmus
Incoordination
Muscle weakness
Atrophy
80
Q

MS (multiple sclerosis) tremors - Associated s/s

A

Intermittent

Nystagmus
Paralysis
Constipation
Muscle weekness
Impotence
81
Q

Work up for CVA

A 
CBC
PT/PTT
Electrolytes
BUN, Creatinine
Glucose
Ca 2+
Magnesium
Sed rate
EKG
CXR
MRI/CT head (no contrast) to exclude a nonvascular lesion, and to determine if the CVA is ischemic infarction or an intracranial hemorrhage.
82
Q

CVA symptoms with decreased platelets and prolonged PT/PTT may indicate

A

hemorrhagic stroke

Adult-Geron Nursing II (1 decks)

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