409 Final 1

Question 1

GBS is a ___ situation

Answer 1

acute

Question 2

Overall description of GBS

Answer 2

Its an acute inflammatory syndrome, where the nerves lose their myelin sheath

Question 3

GBS affects the peripheral nervous system which means it affects

Answer 3

sensory and motor stuff

Question 4

GBS produces ____ motor weakness

Answer 4

progressive

Question 5

GBS: where do the symptoms usually start

Answer 5

in the legs, and then work their way up

Question 6

GBS: ascending paralysis means

Answer 6

the symptoms start in the legs and work their way up

Question 7

How does healing occur in GBS

Answer 7

in the reverse order that symptoms progressed in

Question 8

GBS: the general result of destruction of the myelin sheath is

Answer 8

it messes up nerve impulses

Question 9

GBS is an acute disorder but it’s possible

Answer 9

to have permanent damage

Question 10

GBS: the cause is unknown, but a clue can be that they had ___ or ___

Answer 10

epstein-barr or cytomega

Question 11

GBS: Viruses like epstein-barr could cause the body’s

Answer 11

immune system to react in a messed up way and start attacking itself (which is GBS)

Question 12

What do you teach PD patients about walking

Answer 12

do NOT look at your feet to prevent falls

Question 13

PD: why might it be a bad idea to drive

Answer 13

they could have trouble sleeping at night, might fall asleep while driving

Question 14

PD: they could have trouble communicating. What should you teach them

Answer 14

speak slowly, take deep breaths, exaggerate words if needed

Question 15

PD: not all of them have dementia but

Answer 15

its common to have some kind of cognitive problem

Question 16

PD: if they feel really embarrassed

Answer 16

dont FORCE them into social situations

Question 17

Whats a good exercise for PD patients

Answer 17

light aerobic

Question 18

PD: if drugs don’t help,

Answer 18

the last resort is surgery

Question 19

Stereotactic Pallidotomy/Thalamotomy
Deep Brain Stim
Fetal Tissue Trans

Answer 19

Surgical tx for PD

Question 20

A stroke happens when

Answer 20

there’s not enough blood to the brain

Question 21

Stroke: There will be damage to the infarction area and maybe also

Answer 21

damage to the opposite side (contralateral) because of brain swelling

Question 22

2 main types of stroke

Answer 22

Ischemic and Hemorrhagic

Question 23

Types of ischemic stroke

Answer 23

Thrombotic and Embolic

Question 24

Types of Hemorrhagic stroke

Answer 24

Aneurysm
HTN
Arteriovenous malformation

Question 25

The most common type of stroke is

Answer 25

Ischemic (as opposed to hemorrhagic)

Question 26

What kind of ischemic stroke develops slowly over minutes of hours

Answer 26

Thrombotic

Question 27

In an embolic stroke, the emboli usually comes from

Answer 27

the heart

Question 28

Stroke at night vs stroke in the day

Answer 28

Both kinds of ischemic strokes happen at night, the hemorrhagic strokes happen in the day

Question 29

After the initial onset, hemorrhagic stroke signs

Answer 29

keep getting worse, because you keep bleedings (whereas with embolic stroke you might start to see some improvement after onset)

Question 30

Stroke: if the symptoms come and go,

Answer 30

that might just be a TIA or reversible ischemic neuro deficit

Question 31

Reversible ischemic neuro deficit last

Answer 31

longer than 24 hours

Question 32

Compared to Reversible ischemic neuro deficits, TIAs are

Answer 32

are shorter, sometimes only an hour

Question 33

Stroke: by the time they get to the ED its often resolved

Answer 33

TIA

Question 34

Medication for a TIA

Answer 34

clopi (antiplatelet)

Question 35

Stroke: if they suddenly say I have the worst headache of my life it could be

Answer 35

Aneurysm

Question 36

When a stroke patient comes to the ED, the most important thing to assess is

Answer 36

LOC

Question 37

To maintain perfusion during a stroke, you want the BP

Answer 37

to be a little high, 150/100

Question 38

Stroke: assess for emotional swings if

Answer 38

the frontal lobe is involved

Question 39

Stroke: the ECG might show

Answer 39

decreased T wave ST depression prolonged QT interval

Question 40

For ischemic strokes, start 2 IV lines with

Answer 40

non-dextrose saline

Question 41

Stroke: If the thrombus is in the carotid artery

Answer 41

they can do an endarterectomy, otherwise they need thrombolytics

Question 42

You need to give TPA within

Answer 42

3 hours

Question 43

Ischemic stroke: After you give TPA, if sys is greater than 180 or dys is greater than 105

Answer 43

they may need anti-hypertensives

Question 44

Ischemic stroke: Don't insert a urinary catheter until they're stable because

Answer 44

you don't want to cause bleeding

Question 45

Ischemic stroke: If you detect ICP

Answer 45

escalate immediately

Question 46

ICP: only suction if

Answer 46

they really need it because suctioning increases ICP

Question 47

ICP: how should you handle various care tasks

Answer 47

do NOT cluster them because that'd increase ICP, you need to space them out

Question 48

ICP: if sys is greater than 200

Answer 48

notify provider and recommend anti-HTN meds

Question 49

Stroke: The goals of long term drug therapy are

Answer 49

Prevent future stroke | Prevent hypoxic damage to nerves

Question 50

Stroke: aspirin consideration

Answer 50

an initial dose should be given, but not if they got TPA within 24 hours

Question 51

Stroke: you may need a CCB to prevent

Answer 51

vasospasm

Question 52

Vasospasm tends to happen ____ after stroke

Answer 52

a week

Question 53

Stroke: What kind of environment do you want them to eat in

Answer 53

low stimulus (so they don't get distracted and choke)

Question 54

Stroke: for patients with receptive aphasia, speak

Answer 54

slowly but not loudly

Question 55

Stroke: for patients with receptive aphasia, don't communicate using

Answer 55

yes or no questions (because they might just give an automatic response)

Question 56

Stroke: You should approach the patient on their ___ side

Answer 56

unaffected

Question 57

Stroke: When getting dressed they should do their ___ side first

Answer 57

affected

Question 58

GBS: ask about pins and needles aka

Answer 58

parasthesias

Question 59

GBS: most people report a sudden

Answer 59

muscle weakness

Question 60

GBS: you don't have problems with ___ or ___

Answer 60

LOC or pupils

Question 61

GBS: tx could include ___ or ___ but not both

Answer 61

PE or immunoglobulin

Question 62

GBS: don't give ___ unless you really have to

Answer 62

steroids

Question 63

GBS: keep HOB

Answer 63

at least 45 degrees

Question 64

GBS: keep them on a cardiac monitor because

Answer 64

they're at risk for dysrhythmia

Question 65

GBS: hypotn is treated with

Answer 65

fluids and place them in supine (unless they're really having trouble breathing)

Question 66

GBS: bradycardia is treated with

Answer 66

Atropine

Question 67

GBS: pain is usually treated with opiates. We might use TCAs but don't give them to

Answer 67

older adults