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7th Semester > 400 Exam 6 > Flashcards

400 Exam 6 Flashcards

1
Q

ϖ Organisms enter the brain in 2 ways

A

o Through the bloodstream from spreading infections

o Direct invasion through a skull fracture or bullet hole

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2
Q

example of the bloodstream from spreading infections

A

sinusitis, otitis media, or pneumonia

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3
Q

ϖ Patient who are _____ ______ have increased risk for central nervous system infections

A

HIV positive

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4
Q

3 major types of central nervous system infections

A

meningitis
encephalitis
brain abcessess

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5
Q

ϖ Inflammation of the lining around the brain and spinal cord caused by bacteria, viruses, or fungal infections

A

MENINGITIS

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6
Q

♣ Usually self-limiting and does not require extensive treatment

A

viral meningitis

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7
Q

treatment of viral meningitis

A

No ATB

only Tx the symptoms

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8
Q

viral meningitis can be secondary to?

A

lymphoma
leukemia
HIV

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9
Q

most common cause of viral meningitis

A

enterovirus

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10
Q

sx of viral meningitis

A

mild flu-like symptoms

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11
Q

bacteria in the nasopharynx can enter the blood stream during URI and travel to the CSF and brain

A

o Bacterial (septic meningitis)

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12
Q

what increases the risk for bacterial meningitis

A 
tobacco use
viral upper resp infection
otitis media
mastoiditis
lyme disease
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13
Q

bacterial meningitis is a medical _____

A

emergency

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14
Q

it is important to manage what with bacterial meningitis

A

fever and headache

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15
Q

where will bacterial meningitis patients usually be at?

A

ICU

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16
Q

mortality rate with bacterial meningitis is 5-10% within how many hours of diagnosis

A

24-48 hours

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17
Q

sx of bacterial meningitis

A 
photophobia
double vision
petechial rash
disorientation and memory impairment
behavioral manifestations
increased ICP
N/V
Seizures/Coma
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18
Q

= extreme light sensitivity (cause is unknown)

A

• Photophobia

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19
Q

with purpuric (purple) lesions – striking feature of N. meningitis

A

• Petechial rash

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20
Q

where does the petechial rash start?

A

on the trunk then goes to all over body

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21
Q

decreased level of consciousness and focal motor deficits

A

• Increased ICP –

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22
Q

sx of Increased ICP –

A

drowsiness
sleepiness
hard to arouse
HA

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23
Q

Frequently occurs in dense populations (colleges, high schools, military instillations)—any areas where people conjugate (together a lot)

A

ϖ Neisseria meningitidis

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24
Q

– classic signs of meningitis

A

o Severe Headache and nuchal rigidity

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25
Q

o Viral manifestations much less severe than _____.

A

bacterial

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26
Q

a stiff and painful neck – attempts at flexion of the neck is difficult because of spasms in the muscles in the neck

A

Nuchal rigidity =

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27
Q

_____ tends to remain high throughout illness with meningitis

A

♣ Fever

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28
Q

______ is usually either steady or throbbing and very severe as a result of meningeal irritation

A

♣ Headache

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29
Q

the inability of the patient to extend the leg when the hip is flexed on the abdomen

A

(+) Kernig’s sign

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30
Q

when the patients neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; more sensitive indicator of meningeal irritation than Kernig’s

A

(+) Brudzinski’s sign

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31
Q

diagnostic tests for meningitis

A

CT/MRI
CSF studies
Spinal Tap

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32
Q

♣ CSF studies indicate

A

low glucose, high protein levels, and high WBC count

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33
Q

o Researchers have developed a bedside risk score for unfavorable outcomes (poorer the prognosis)

(What makes meningitis have a poorer prognosis)

A 
♣	Older age
♣	Heart rate greater than 120
♣	Low Glasgow coma score
♣	Cranial nerve palsies
♣	Positive gram stain 1 hour after presentation to the hospital
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34
Q

ϖ Prevention is key for meningitis

A

meningococcal conjugated vaccine given to high school students and college students

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35
Q

o People living in close contact with patients with meningitis should be treated how?

A

prophylactically usually with some type of antimicrobial chemoprophylaxis.

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36
Q

when are people no longer contagious with meningitis

A

Antibiotics for 24 hours

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37
Q

ATB should be given within ___ hours of meningitis

A

24 hours.

within 30 min in the hospital

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38
Q

what type of isolation with meningitis?

A

droplet precautions!!

airborne precautions

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39
Q

what type of room with meningitis?

A

reverse isolation

respiratory isolation room

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40
Q

medication for meningitis

A

Penicillin G
cephalosporins
Dexamethasone

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41
Q

which 2 meds are administered together within 30 min of hospital arrival for meningitis patients?

A

Penicillin G

Cephalosporins

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42
Q

decreases inflammation

steroid due to ICP

A

dexamethasone

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43
Q

when is dexamethasone given for meningitis?

A

♣ Administered 15-20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days

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44
Q

meningitis patients may have hydrocephalus which makes them need a ?

A

SHUNT

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45
Q

what type of precautions for meningitis?

A

seizure

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46
Q

how to prevent seizures?

A 
padded side rails
Never force anything in someone’s mouth is clench
Head of bed up
Side lying position 
Pad with towels, no pillows!!
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47
Q

what med to prevent seizure precautions?

A

phenytoin

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48
Q

how often to assess neuro and VS for meningitis?

A

q 2 hrs

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49
Q

what type of environment with meningitis?

A

private, quiet, dark room

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50
Q

ϖ An acute infection of the brain parenchyma (nervous tissue found in the brain) and meninges caused by bacteria, viruses, or fungi

A

Herpes Simplex Virus encephalitis

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51
Q

o Local hemorrhage within the brain that becomes more generalized followed by edema and deterioration of nerve cell bodies

A

Herpes Simplex Virus encephalitis

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52
Q

o Once hemorrhage starts with Herpes Simplex Virus encephalitis, experience edema that leads to???

A

increased ICP

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53
Q

sx of Herpes Simplex Virus encephalitis

A 
Fever, 
headache, 
stiffness in neck (not as severe as meningitis), 
increased ICP, 
seizures, 
decrease LOC, 
lethargy, 
coma, 
dysphagia, 
hemiparesis, 
skin lesions
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54
Q

nerve tissue are affected with Herpes Simplex Virus encephalitis that cause?

A

Residual effect
Cognitive function impairment
personality changes, dementia
can be left deaf or blind

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55
Q

how to Dx Herpes Simplex Virus encephalitis

A

EEG

spinal tap
CSF

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56
Q

shows diffuse slowing or focal changes in the temporal lobe

A

o EEG –

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57
Q

how to treat Herpes Simplex Virus encephalitis

A 
acyclovir
ganciclovir
morphine/dilaudid
steroids
anticonvulsants
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58
Q

♣ Early administration improves prognosis

♣ Inhibits viral DNA replication

♣ Prevent relapse continue treatment for up to 3 weeks

♣ Slow IV administration over 1 hour to prevent crystallization of the med in the urine

A

acyclovir and ganciclovir

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59
Q

nursing management for patient with Herpes Simplex Virus encephalitis

A

assess neuro function q 2 hours

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60
Q

o Comfort measures to reduce headache for Herpes Simplex Virus encephalitis

A

dimming lights, limiting noise and visitors, grouping nursing interventions, administering analgesic meds

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61
Q

o why are Opioids are used cautiously in patient with encephalitis –

A

may mask neuro symptoms

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62
Q

o Arthropod-borne virus vectors

(AKA arbovirus

A

mosquitoes, ticks, psychodids (type of moth)

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63
Q

o Vector borne encephalitis

A

west Nile

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64
Q

(fungal encephalitis is usually with?

A

AIDs patients
CA
Immunocompromised

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65
Q

treatment of fungal encephalitis

A

antifungals

amphotericin B
fluconazole

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66
Q

causes major flu-like symptoms; fever, nausea, vomiting

A

♣ Amphotericin B—

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67
Q

maculopapular skin rash. lymph node enlargement. paralysis

A

west nile

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68
Q

nursing care of encephalitis

A 
o	Ineffective protection
o	Assess LOC continually
o	Monitor memory impairment 
o	Monitor ICP
o	Monitor vitalsseptic shock; increased BP and decreased pulse
o	Monitor fever
Monitor for seizure activity 
o	Monitor for cranial nerve damage
o	Administer medications as needed
Risk for imbalanced fluid volume
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69
Q

ϖ Spongiform encephalopathy – degenerative, infectious neuro disorder
\
ϖ Rapidly progressive, degenerative, neurologic disease that causes brain degeneration WITHOUT inflammation

A

Creutzfeldt – Jakob Disease (CJD

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70
Q

CJD has no identifiable cause. however vCJD results from?

A

ingesting infected meat

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71
Q

ϖ Risk of ____ in US in thought to be low because cattle are fed primarily with grass, wheat, and soy-derived feed as opposed to feed containing animal parts

A

CJD

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72
Q

ϖ Clinical manifestations vCJD:

A 
behavioral changes, 
sensor disturbances, 
limb pain, 
muscle spasms, 
rigidity, 
dysarthria, 
incoordination, 
cognitive symptoms and 
sleep disturbances.
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73
Q

ϖ Clinical manifestations CJD: ]

A 
mental deterioration, 
ataxia, 
visual disturbances, 
memory loss, 
involuntary movement, 
paralysis, and 
mute
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74
Q

diagnosis of CJD or vCJD

A

EEG
MRI
CSF

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75
Q

o reveals a characteristic pattern over duration of the disease
♣ Shows burst-suppressions characterized by periodic spikes alternating with slow periods

A

EEG

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76
Q

treatment of CJD/vCJD

A

supportive and palliative care

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77
Q

o Goals of care with CJD

A

promotion of comfort measures, prevention of injury related to immobility and dementia, and provision of support and education for family

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78
Q

ϖ Prevention of disease transmission is an important part of nursing care of CJD

A

standard precautions

DISPOSABLE INSTRUMENTS

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79
Q

Why are disposable instruments used for CJD

A

sterilization methods do not destroy the prion

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80
Q

ϖ Autoimmune disorder progressive demyelinating disease of the CNS

A

Multiple Sclerosis (MS)

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81
Q

2 types of MS

A

relapsing/remitting (RR)
or
Primary Progressive MS

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82
Q

o Exacerbations followed by remissions

Can occur over several days or week then get better

A

relapsing/remitting (RR)

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83
Q

o Exacerbations occur but do not normally return to baseline function

o As the nerve fibers become increasingly damaged so does the disabilities for the patient

o Usually in wheel chair

A

Primary Progressive MS

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84
Q

sx of MS

A 
fatigue and pain *****
depression
weakness
numbness
difficulty in coordination
loss of balance
eye issues
cognitive and psychomotor changes
bladder, bowel, sexual dysfunction
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85
Q

may contribute to fatigue with MS

A

heat, depression, anemia, deconditioning, and meds

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86
Q

how to avoid fatigue with MS

A

avoid heat!!!!!

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87
Q

secondary complications with MS

A 
UTIs
constipation
pressure ulcers
high risk for falls and injury
malnutrition
conracture deformities
dependent pedal edema
pneumonia
reactive depression
osteoporosis
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88
Q

o Certain things can exacerbate symptoms of MS:

A

heat, extreme cold, stress

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89
Q

o MRI will show multiple ____ on the brain in the CNS with multiple sclerosis. If plaques do not show up on MRI will do a CSF analysis.

A

plaques

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90
Q

o Electrophoresis of CSF identifies presence of ______ _______ – several bands of immunoglobulin G bonded together, indicating an immune system abnormality

A

oligoclonal banding

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91
Q

collaborative management for MS

A

keep patient independent
no cure
die of complications (pneumonia)

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92
Q

main treatment for MS

A

interferon beta 1A (Rebif)

interferon beta 1B (Betaseron)

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93
Q

• Interferon beta meds can cause major ____-___ symptoms

A

flu-like

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94
Q

flu-like symptoms can be managed with

A

acetaminophen and ibuprofen and resolve after a few months

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95
Q

• Additional side effects of interferon meds for MS

A

potential liver damage, fetal abnormalities, and depression

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96
Q

• Optimal control of disability, interferon meds should be started when with MS?

A

at the first sign of MS

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97
Q

• reduces rate of relapse in the relapsing remitting (RR) MS

A

Glatiramer acetate

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98
Q
  • Steroid key agent in treating acute relapse in RR

* Shortens duration of relapse but no long term effects

A

♣ IV methylprednisone

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99
Q

Medication of choice for spasticity with MS

A

Baclofen

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100
Q

other med to treat spasticity with MS

A

benzo’s

diazepam
tizandinine
dantrolene

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101
Q

• Treats fatigue that interferes with ADLs with MS

A

Amantadine
pemoline
dalfampridine

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102
Q

• may be used to treat bladder and bowel problems with MS

A

♣ Anticholinergics, alpha-adrenergic blockers, anti-spasmodics

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103
Q

may be given also to acidify the urine and prevent bacterial growth in MS patients

A

• Ascorbic acid (vitamin C)

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104
Q

assessment with MS

A

o Assess for weakness, spasticity, visual impairments, bowel and bladder problems

o Assess for impaired speech or swallowing high risk for aspiration

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105
Q

ND with MS

A 
o	Impaired physical mobility 
o	Risk for injury/fall 
o	Impaired urinary and bowel elimination
o	Impaired verbal communication
o	Impaired speech or swallowing
o	Risk for aspiration
o	Disturbed thought processes as disease progresses 
o	Ineffective individual coping 
o	Impaired home maintenance
o	Potential for sexual dysfunction
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106
Q

how to Minimize spasticity and contractures with MS

A 
♣	ROM exercise, 
physical therapy, 
warm packs (not hot bath), 
stretching, 
balance rest and activity
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107
Q

how to minimize effects of immobility with MS

A

Pressure ulcers (Turn q 2),
pressure relieving devices if in wheelchair (egg crate),
coughing and deep breathing (prevent pneumonia).

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108
Q

o Preventing injury with MS

A

walk with wide based gait and stand up straight,
keeping room free of clutter is a priority,
protect the extremities,
double vision (eye-patch)

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109
Q

what type of diet with MS

A

soft diet with thickened liquids

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110
Q

o As MS progresses referred to ____ ____. Once it is progressively worsens ____ _____.

A

home health;

hospice care

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111
Q

ϖ A rare, chronic disease that affects the myoneural junction
ϖ Exact etiology is unknown, thought to be an autoimmune response

A

Myasthenia Gravis

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112
Q

who is more likely to have MG

A

women

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113
Q

ϖ Believed that the ____ ____ plays an active role in the autoimmune response of MG

A

thymus gland

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114
Q

o Antibodies directed at the acetylcholine receptor sites impair transmission of impulses varying degrees of weakness of the voluntary muscles

A

Myasthenia Gravis

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115
Q

sx of MG

A 
muscle weakness 
generalized fatigue
ptosis
diplopia
bulbar symptoms
hand and arm difficulties
difficulty walking and sitting
bland facial expression
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116
Q

o Myasthenia gravis is purely a motor disorder with NO effect on _______ or ______.

A

sensation or coordination

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117
Q

weakness of the muscles of the face and throat

A

o Bulbar symptoms –

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118
Q

diagnosis of MG

A

history and symptoms
Tensilon Test (Edrophonium chloride)
EMG
MRI

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119
Q

♣ ______ should be available to control side effects of Tensilon –

A

Atropine

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120
Q

sx of Tensilon

A

bradycardia, sweating, cramping

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121
Q

Tensilon Test (Edrophonium chloride) is contraindicated in patients with _____ patients

A

cardiac

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122
Q

what test is done when Tension test is contraindicated

A

ice test

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123
Q

♣ Ice packs over eyes for 1-2 minutes and symptoms will temporarily resolve

A

Ice test

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124
Q

if droop improves after ice test. result is _____

A

positive.

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125
Q

detects a delay or failure of neuromuscular transmission (looks at muscle fibers)

A

o EMG

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126
Q

the MRI checks for an enlarged ____ ____ with MG

A

thymus gland

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127
Q

plasma exchange technique used to treat exacerbations of MG

A

o Plasmapheresis –

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128
Q

♣ Remove thymus gland since it’s thought that the thymus produces the antibodies
♣ Last resort for patients with severe symptoms

A

thymectomy

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129
Q

o Acute exacerbation of MG is a myasthenic crisis

A 
♣	Respiratory infection or distress
♣	Medication change
♣	Medications that can exacerbate MG
♣	Surgery 
♣	Pregnancy
♣	Stress and/or trauma
♣	Dysphagia – difficulty swallowing
♣	Dysarthria – difficulty speaking
♣	Eyelid ptosis
♣	Diplopia
♣	Prominent muscle weakness
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130
Q

myasthenia crisis patients will be where

A

in ICU for constant monitoring

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131
Q

over medicate with cholinesterase inhibitors
toxic response to medication

♣ Profound weakness, copious secretions, and eventually respiratory failure

A

o Cholinergic crisis

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132
Q

should be on hand to treat bradycardia and respiratory distress.

A

♣ Atropine sulfate

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133
Q

if they have MG but not in crisis

A

treated at home

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134
Q

MG in crisis

A

monitoring accurate neurological and respiratory is essential

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135
Q

most common cause of death with MG

A

respiratory failure

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136
Q

what will MG patients get before eating?

A

Pyridostigmine

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137
Q

• Helps to improve swallowing and to eat better to reduce the risk of aspiration

A

Pyridostigmine

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138
Q

ϖ Autoimmune attack on the peripheral nerve myelinacute, rapid segmental demyelination of peripheral nerves and some cranial nerves

A

Guillain-Barre Syndrome

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139
Q

symptoms of GBS

A 
ascending weakness with dyskinesia
hyporeflexia
paresthesias
optic nerve demyelination
vagas nerve demyelination
NO loss of LOC
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140
Q

inability to initiate voluntary movement

A

♣ Dyskinesia

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141
Q

sensation of numbness, tingling, or “pin and needles”

A

♣ Paresthesias

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142
Q

worry about ___ _____ with GBS

A

respiratory paralysis

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143
Q

o Usually some kind of event that occurs about 2 weeks prior to GBS

A

(flu shot, Epstein-Barr virus, HIV)

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144
Q

o Optic nerve demyelination may lead to _____.

A

blindness

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145
Q

o Vegas nerve demyelination leads to?

A

cardiac issues like bradycardia, tachycardia, hypertension, orthostatic hypotension

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146
Q

ϖ May take up to ___ years for full recovery with GBS – some patients may not fully recover

A

2

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147
Q

diagnosis of GBS

A

history and physical and patients symptoms

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148
Q

o Monitoring for life-threatening complications of GBS include:

A

respiratory failure,
cardiac manifestations,
DVT,
PE

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149
Q

GBS patients will be on continuous ____ ______

A

ECG/telemetry monitoring

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150
Q

what should nurse do for paralysis with GBS

A

PROM

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151
Q

ϖ Exact cause unknown

ϖ Involuntary contraction of the facial muscles causing

o Sudden closure of the eye

o Twitching of the mouth

o Usually unilateral

A

Trigeminal Neuralgia

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152
Q

Trigeminal Neuralgia is a condition of the ____ cranial nerve

A

5th

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153
Q

ϖ with Trigeminal Neuralgia Pain is usually related to

A

a stimulation of the trigeminal of the affected nerve branches

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154
Q

what causes pain with Trigeminal Neuralgia

A

o Touching face/washing face
o Brushing teeth
o Eating
o Drinking food that is too hot/cold

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155
Q

nursing management of Trigeminal Neuralgia

A

prevent pain

provide post-op care

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156
Q

how to prevent pain

A 
pain meds
Avoid things that make pain worse
cotton pads and room temp water to wash face
rinse with mouth wash after eating
perform personal hygiene at pain-free intervals
take food and fluids at room temp
chew on unaffected side
ingest soft foods
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157
Q

Bell’s palsy facial paralysis caused by unilateral inflammation of the ___ cranial nerve

A

7th

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158
Q

o Face become distorted from paralysis
o Decreased lacrimation and painful sensations in the face, behind the ear, and in the eye
o May have difficulties swallowing and eating
o Cause unknown

A

Bell’s palsy

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159
Q

o Goal for Bell’s Palsy

A

maintain muscle tone in face and prevent/minimize denervation

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160
Q

ϖ Nursing management of Bell’s palsy

A

protection of eye from injury while paralysis lasts

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161
Q

ϖ Natural barriers of absorption that diminish the efficacy of ocular medications include the following:

A

o Limited size of the conjunctival sac
o Corneal membrane barriers
o Blood-ocular barriers
o Tearing, blinking, and drainage

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162
Q

ϖ _____ solutions are most commonly used for the eye

A

Aqueous

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163
Q

(instilled eye drops and applied ointments) are the most commonly used for ocular disorders

A

o Topical routes

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164
Q

• Major disadvantage of ointments is ____ _____ – can last for a while after application which would be a safety issue

A

blurred vision

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165
Q

o Used before diagnostic procedures or for pts having severe eye pain

A

ϖ Topical Anesthetic Agents

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166
Q

o Anesthesia occurs between ___-___ and can last ___-___ min
with Topical Anesthetic Agents

A

20 seconds - 1 minute and can last from 10 - 20 minutes

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167
Q

o Nurses must educate pts to not ____ _____ – this can cause corneal damage with topical anesthetic agents

A

rub eyes

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168
Q

overuse of Topical Anesthetic Agents can cause

A

softening of the cornea

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169
Q

o Prolonged use of topical anesthetic agents can result in

A

delayed healing & can lead to permanent corneal opacification and scarring, resulting in visual loss

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170
Q

o Usually used in combo for max. pupil dilation

A

ϖ Mydriatic and Cycloplegic Agents

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171
Q

education with Mydriatic and Cycloplegic Agents

A

temporary glare, inability to focus properly, difficulty reading

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172
Q

effects of Mydriatic and Cycloplegic Agents can last?

A

3 hours to several days

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173
Q

advise to wear _____ with Mydriatic and Cycloplegic Agents

A

sunglassess

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174
Q

Mydriatic and Cycloplegia agents affect the CNS and are most prominent in younger and older adults – these pts must be assessed closely for symptoms such as:

A
  • Increased BP
  • Tachycardia
  • Dizziness
  • Ataxia
  • Confusion
  • Disorientation
  • Incoherent speech
  • Hallucinations
175
Q

Mydriatic and Cycloplegia agents are Contraindicated in

A

pts w/ narrow angles or shallow anterior chambers and in pts taking MAOI’s or tricyclic antidepressants

176
Q

Includes antibiotics, antifungals, antivirals

A

ϖ Anti-Infective Medications –

177
Q

main antifungal med

A

amphotericin B

178
Q

amphotericin B has serious side effects such as:

A

Severe pain

Conjunctival necrosis

Inflammation or irritation of the iris (Iritis)

Retinal toxicity

179
Q

o Used for inflame conditions of eye

A

ϖ Corticosteroids and NSAIDS

180
Q

education with Corticosteroids and NSAIDS

A

shake the bottle prior to use if it is a suspension

181
Q

o Most common ocular side effect of long term topical corticosteroid administration include:

A 
•	Glaucoma
•	Cataracts
•	Susceptibility to infection
•	Impaired wound healing
•	Mydriasis
•	Ptosis
Increase in IOP
182
Q

which side effect of topical corticosteroid use is reversible?

A

increased IOP

183
Q

o Common for a pt with allergies

A

ϖ Anti-allergy Medications

184
Q

May be used to irrigate the eye or for pts with dry eyes such as artificial tears

A

ϖ Ocular Irrigants and Lubricants –

185
Q

Nursing Management for Pts Receiving Ocular Medications

A

ϖ Need to ensure proper administration to maximize the therapeutic effects

186
Q

ϖ To diminish systemic absorption and minimize side effects of ocular medications, it is important to:

A

o Put gentle pressure on the inner canthus/puncta of the eye for 1 to 2 mins immediately after instilling eye drops

o Wait at least 5 mins before instilling another eye drop, and 10 mins before instilling another ointment into the eye

187
Q

ϖ Second leading cause of blindness in adults in the US

ϖ A group of ocular conditions characterized by ocular nerve damage related to increased intraocular pressure from congestion of aqueous humor in the eye

ϖ Aqueous humor flows between the iris and the lens and nourishes cornea and lens, most of the fluid then flows out through the anterior chamber, drains through trabecular meshwork, when it’s inhibited from flowing out – pressure builds up within the eye

A

Glaucoma

188
Q

what conditions cause increase IOP–which leads to glaucoma

A

DM
inflammation of the eye
retinal detachment

189
Q

risk factors for glaucoma

A 
FH
Thin cornea
AA
Old Age
DM
Cardiovascular Dx
Migraine syndromes
Myopia
eye trauma
prolonged use of corticosteroids
190
Q

nearsightedness

A

myopia

191
Q

Two Types of Glaucoma

A

Open-Angle

Narrowed-Angle

192
Q

o Increase fluid leads to increased IOP, neuronal ischemia and optic nerve degeneration and eventually loss of vision

A

Open-Angle Glaucoma

193
Q

Open-Angle Glaucoma symptoms

A

painless
loss of peripheral vision
increased IOP

194
Q

o Obstruction in aqueous humor outflow due to the complete or partial closure of the angle

A

angle closure (narrowed angle) glaucoma

195
Q

o The obstruction results in an increased IOP, damages the retina neuron and optic nerve which leads to blindness

o Can be an ocular emergency – should be treated immediately

A

angle closure (narrowed angle) glaucoma

196
Q

sx of angle closure (narrowed angle) glaucoma

A 
eye/face pain
malaise
N/V
colored halos around lights
decreased vision
red conjunctiva 
corneal cloudiness
197
Q

Stages of Glaucoma

A
  1. Initiating Event
  2. Structural alterations in the aqueous outflow system
  3. Functional alterations
  4. Optical nerve damage
  5. Visual Loss
198
Q

Must be an initiating event that causes the increased IOP

o Risk factors listed above,
can also include illness, emotional stress, congenital abnormalities, long term use of corticosteroids, and use of mydriatics

A
  1. Initiating event
199
Q

o Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations and may lead to the third stage

not draining properly or no drainage causes pressure to build up

A
  1. Structural alterations in the aqueous outflow system –
200
Q

o Conditions such as increased intraocular pressure or impaired blood flow create functional changes that may lead to the fourth stage

The built up pressure causes functional changes

A
  1. Functional alterations –
201
Q

o Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply

A
  1. Optical nerve damage
202
Q

Progressive loss of vision is characterized by visual field defect – usually starts out with peripheral vision

A
  1. Visual loss –
203
Q

diagnosis of glaucoma

A

tonometry
funduscopy
fundugonioscopy
visual field testing

204
Q

measures intraocular pressure

A

ϖ Tonometry –

205
Q

inspection of optic fundus w/ ophthalmoscope

A

ϖ Funduscopy –

206
Q

measures the depth of the anterior chamber and determines open angle from closed angle glaucoma

A

ϖ Fundugonioscopy –

207
Q

determines degree of visual field narrowing

A

ϖ Visual field testing –

208
Q

types of surgeries for glaucoma

A 
Trabeculoplasty; 
trabeculectomy; 
gonioplasty; 
laser iridotomy; 
peripheral iridectomy
209
Q

ND for glaucoma

A

o Disturbed Sensory Perception: Visual
o Risk for Injury
o Anxiety

210
Q

ϖ Clouding of the lens of the eye that interferes with light transmission
ϖ

Light scatters and does not have sharp vision
ϖ Can develop in one eye or both eyes

A

CATARACTS

211
Q

sx of Cataracts

A 
painless
blurry vision
light scattering
myopic shift
astigmatism
color shift
brunescens
reduced visual acuity
212
Q

return of ability to do close work without eyeglasses

A

ϖ Myopic shift –

213
Q

color values shift to yellow brown

A

ϖ Brunescens –

214
Q

diagnosis of cataracts

A

snellen visual acuity test
opthalamoscope
slit-lamp biomicroscopic exam

215
Q

treatment of cataracts

A

surgery

216
Q

how will they do the cataract surgery

A

1 eye at a time.

weeks to months in between surgeries

217
Q

ϖ Lens are broken apart and extracted and they will get some type of lens implant

A

cataract surgery

218
Q

3 replacement options for cataract surgery

A

o Aphakic eyeglassess
o Contact lenses
o Intraocular lens implants

219
Q

most common replacement option for cataract surgery

A

intraocular lens implants

220
Q

lens in them to better vision

A

o Aphakic eyeglasses –

221
Q

ϖ Potential Early Postop Complication with cataracts

A

o Toxic Anterior Segment Syndrome –

222
Q

Noninfectious inflammation that is a complication of anterior chamber surgery caused by a toxic agent such as agent used to sterilize surgical instruments

A

o Toxic Anterior Segment Syndrome –

223
Q

o effects of Toxic Anterior Segment Syndrome –

A

Corneal edema less than 24 hours postop

224
Q

sx of Toxic Anterior Segment Syndrome

A

o reduced visual acuity and pain

225
Q

treatment of Toxic Anterior Segment Syndrome if theres no growth of MO

A

topical steroids

226
Q

o Alpha-antagonist, particularly tamsulosin (Flomax), are known to cause a condition called \

A

intraoperative floppy iris syndrome

227
Q

o Dilating drops are administered prior to surgery

A

• Every 10 minutes for four doses at least 1 hour before surgery – Additional drops may be administered in the operating room

228
Q

o If an eye patch is worn, it is removed after the first follow up appointment, usually within ___ hours after surgery

A

48

229
Q

o Vision is stabilized when the eye is completely healed, usually within __-___ weeks, when final corrective prescription is complete

A

6 to 12

230
Q

o Patients who choose multifocal IOLs should be aware that there may be increased ??????

A

night glare and contrast sensitivity

231
Q

ϖ Separation of the retina from the sensory layer of eye

ϖ Can occur spontaneously or from trauma to the eye

A

RETINAL DETACHMENT

232
Q

allows perception of light

A

Retina

233
Q

____ _____ can shrink with age and can pull retina from back of eye

A

ϖ Vitreous humor

234
Q

ϖ Detached retina can increase in ___ and increase in ____ ____

A

size; vision loss

235
Q

the retina must be restored back in contact w/ eye or _____ can occur which will result in blindness

A

ischemia

236
Q

sx of retinal detachment

A 
ϖ	Sudden onset of floaters or spots
ϖ	Sensation of curtain coming across the vision of one eye – going black
ϖ	Cobwebs
ϖ	Bright flashing light
ϖ	May have blurred vision
ϖ	Painless
237
Q

diagnosis of rentinal detachment

A

dilated fundus examination
stereo fundus photography
fluorescein angiography
optical coherence tomography

238
Q

– creates inflammation and adhesion to weld layers back together

A

ϖ Cryotherapy or laser photocoagulation

239
Q

causes the fold in sclera to bring the detachment back to contact – contact maintained with a buckle

A

ϖ Scleral buckling –

240
Q

air bubble is injected and pushes retina into contact with layer of the eye

A

ϖ Pneumatic retinopexy –

241
Q

ϖ Postop for Pneumatic Retinopexy

A

o The patient must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break

242
Q

ϖ Education Post Surgery (retinal reattachment)

A

o Activity restriction, no straining to reduce pressure

o Wear an eye shield to protect the eye

243
Q

complications of retinal reattachment surgery

A

increased IOP

infection

244
Q

ϖ Most common cause of vision loss in people over 60

pts develop drusen

A

MACULAR DEGENERATION

245
Q

qdrusen – tiny yellowish spots beneath the retina

A

drusen –

246
Q

drusen affect vision when located where?

A

macular area

247
Q

is the area of the retina that provides sharp vision, if this area becomes degenerative, then macular degeneration of vision loss occurs

A

ϖ Macula

248
Q

with macular degeneration, which vision is most affected

A

central vision

249
Q

causes of macular degeneration

A 
increased age
females
smokers
genetics
long term inflammation of the eye
250
Q

2 types of macular degeneration

A

non-exudative

exudative

251
Q

o Most common type – between 85%-90% of people have dry type

A

non-exudative

252
Q

o Drusen outside of the macular area – no symptoms
o Drusen within the macula – gradual blurring of vision that patients may notice when they try to read
o Usually occurs slowly

A

non-exudative

253
Q

o Formation of new, weak blood vessels between vessel layers and retina
o New blood vessels are weak and prone to leaking, which interferes with vision
o Repeated bleeding will cause scarring
o Straight lines appear crooked and distorted or that letters in words appear broken
o Blurred vision centrally – peripheral vision usually stays intact

A

exudative

254
Q

dx of macular degeneration

A

visual and retina exams

fluorescein angiogram

255
Q

treatment of non-exudative

A

NO CURE

antioxidants and minerals in megadoses can slow the progression of AMD and vision loss

256
Q

treatment of exudative

A

laser surgery

photodynamic therapy meds

257
Q

destroys weak vessels to prevent bleeding

A

laser surgery

258
Q

will adhere to new blood vessels and stop leaking

A

o Photodynamic therapy meds

259
Q

after photodynamic therapy treatment for exudative

A

avoid direct sunlight or bright indoor light for 5 days

260
Q

– grid with straight line—as long as line are straight vision is fine

A

ϖ Amslers grids

261
Q

ϖ Usually associated with a head injury, which MUST be assessed first!

A

orbital trauma

262
Q

ϖ Soft tissue orbital injuries often result in damage to the ___ ____.

A

optic nerve

263
Q

ϖ s/s of orbital trauma from blunt or penetrating trauma include

A 
tenderness, 
ecchymosis, 
lid swelling, 
proptosis or exophthalmos, and 
hemorrhage
264
Q

ϖ Closed injuries lead to contusions w/ subconjunctival hemorrhage, commonly known as a ___ ____.

A

black eye

265
Q

ϖ Management of soft tissue hemorrhage is usually conservative

A

o Inspection, cleansing and repair of wounds

o Cold compresses are used in the early phase, followed by warm compresses

266
Q

ϖ Immediate vision loss after injury is usually ______.

A

permanent

267
Q

o Usually non emergent and require surgical repair

o Detected by facial x-rays

A

ϖ Orbital Fractures

268
Q

o Would do an xray or CT to detect
o Surgical intervention is directed at preventing further ocular injury and maintain the integrity of the affected areas
o Cultures are usually obtained, and the pt is placed on prophylactic IV antibiotics that are later changed to ones in a n oral form

A

ϖ Foreign Bodies

269
Q

ϖ Occurs with occupations injuries, contact sports, weapons, assaults, motor vehicle accidents, and explosions

A

occular trauma

270
Q

ϖ Two main types of ocular trauma include

A

chemical burns and foreign objects in the eye

271
Q

what to do with chemical burns

A

o Immediately irrigate the eye with tap water or normal saline

o pH of the eye should be assessed

272
Q

what to do with foreign bodies

A

o No attempt should be made to remove it

o The object should be protected from jarring or movement to prevent further ocular damage

o Wouldn’t want to put any type of pressure or patch on the affected eye

273
Q

Splash injuries medical management

A

irrigate with NS
ATBs
tetanus antitoxin
any topical ophthalmic meds must be sterile

274
Q

ϖ Foreign bodies and corneal abrasions medical management

A

removed by physician

ATBs

275
Q

is a common cause of corneal abrasion

A

o Contact lens wear

276
Q

o Topical anesthetic eye drops must not be given to the patient to take home for repeated use after corneal injury because their effects mask further damage, delay healing, and can lead to ____ ____

A

corneal scarring

277
Q

o Most penetrating injuries result in marked vision loss and usually have the following manifestations:

A 
♣	Edema of the conjunctiva 
♣	Conjunctival laceration
♣	Shallow anterior chamber with or without an eccentrically placed pupil
♣	Hyphema 
♣	Vitreous hemorrhage
278
Q

(blood within the anterior chamber)

A

hyphema

279
Q

– Should avoid an MRI because if it’s metal it could further damage the patient

A

ϖ Intraocular Foreign Body

280
Q

result in the most severe injury because they penetrate the ocular tissues rapidly and continue to cause long-term damage – can also cause increased IOP

A

o Alkali burns

281
Q

generally cause less damage because the precipitated necrotic tissue proteins form a barrier to further penetration and damage

A

o Acids (bleach, car batteries, refrigerant)

282
Q

– Burns related to heat or reflections from snow, sun gazing, etc.

A

ϖ Thermal Injury

283
Q

treatment for thermal injury

A

o Antibiotic agents and a pressure patch for 24 hours constitute the treatment of mild injuries

284
Q

HEARING LOSS Can be ___, ____, ____, or ____.

A

partial, total, congenital, or acquired

285
Q

risk factors for hearing loss

A 
ϖ	Family hx of sensorineural impairment 
ϖ	Congenital malformations of the ear
ϖ	Low birth weight—esp. NICU babies
ϖ	Use of ototoxic medications
ϖ	Recurrent ear infections
ϖ	Bacterial meningitis
ϖ	Chronic exposure to loud noises
ϖ	Perforation of the tympanic membrane
ϖ	Aging
ϖ

Lesions in outer, middle, or inner ear
ϖ

Central auditory pathways

286
Q

symptoms of hearing loss

A 
speech deterioration
fatigue
indifference
social withdrawal
insecurity
indecision and procrastination
suspiciousness
false pride
loneliness and unhappiness
tendency to dominate the conversation
287
Q

ototoxic substances

A 
diuretic agents
chemo
antimalarial agents
chemicals
aminoglycoside ATBs
ATBs
metals
288
Q

4 types of hearing loss

A

conductive hearing loss
sensorineural hearing loss
mixed hearing loss
functional hearing loss

289
Q

o Anything that disrupts sounds from external canal to internal ear

o Equal hearing loss at all frequencies

A

conductive hearing loss

`

290
Q

what will help with conductive hearing loss

A

talking loud or hearing aids

291
Q

conductive hearing loss can include:

A 
Obstruction of external ear canal
Impacted cerumen
Edema due to infection (bad ear infection)
Perforated tympanic membrane 
Disruption of bone in the ear
292
Q

o May effect inner ear, auditory nerve or auditory pathways in the brain

o Nerve problem – sound waves are interpreted correctly, but inner ear has lost the ability to receive or interpret the sounds

A

ϖ Sensorineural Hearing Loss

293
Q

ϖ Sensorineural Hearing Loss can be caused by:

A 
♣	Loud noise exposure
♣	Ototoxic drugs/Chemotherapy
♣	Prenatal exposure to rubella
♣	Viral infections
♣	Meningitis
♣	Trauma
♣	Aging
294
Q

do hearing aids and talking loud help sensorineural hearing loss?

A

NO because they can’t hear high frequency tones!!

295
Q

– Gradual hearing loss that occurs throughout life

A

ϖ Presbycusis

296
Q

ϖ Presbycusis is associated with what type of hearing loss?

A

sensorineural hearing loss due to degenerating cochlea

297
Q

o Inability to hear high frequency sounds, followed in time by the loss of middle and lower frequencies
o Hearing aids are useful

A

Presbycusis

298
Q

sx to watch for with presbycusis

A

cupping of an ear with hand
difficulty understanding others
need to see speaker while talking

299
Q

diagnostic tests for hearing loss

A 
o	Rinne and Weber tests
o	Audiometry
o	Speech audiometry
o	Tympanometry
o	Acoustic reflex testing
300
Q

o Makes sounds louder, but does not improve a patients ability to discriminate words or understand speech

A

hearing aids

301
Q

is the only part of the hearing aid that may be washed frequently

A

• The ear mold

302
Q

• Wash ear mold how often and with what

A

daily with soap and water

303
Q

• Check for malfunctions with hearing aids:

A

o Is the switch on properly?
o Are the batteries charge and positioned correctly?
o Is the ear mold clogged w/ cerumen?

304
Q

common complications with hearing aids

A

external otitis media and pressure ulcers in the external auditory canal

305
Q

ϖ Inner ear is called the ____.

A

labyrinth

306
Q

is the fluid within the ear canals and in the inner ear that helps maintain equilibrium

A

ϖ Endolymph

307
Q

ϖ When this area becomes inflamed, balance is effected and hearing loss can occur

A

inner ear

308
Q

ϖ Inner ear disorders can affect what 2 things?

A

equilibrium and perception of sound

309
Q

used frequently by patients and health care providers to describe any altered sensation of orientation in space

o More common in women and in older adults

A

ϖ Dizziness –

310
Q

the misperception or illusion of motion of the person or the surroundings
o Describe it as a spinning sensation or say they feel as though objects are moving around them

A

Vertigo –

311
Q

is a failure of muscular coordination and may be present in patients with vestibular disease

A

ϖ Ataxia

312
Q

involuntary rhythmic movement of the eyes

A

ϖ Nystagmus –

313
Q

ϖ Buzzing, roaring or ringing sound in the ear with no noise associated with it
ϖ Can be associated with conductive or sensorineural hearing loss

A

tinnitus

314
Q

what meds can cause tinnitus

A

aspirin, quindien or qulaididne toxicity

315
Q

what else can cause tinnitus

A

obstruction in the ear,
possibly infections,
Meniere’s disease

316
Q

ϖ Inflammation of inner ear

ϖ Can be caused by bacteria and other viruses

A

Labyrinthitis (otitis internia)

317
Q

common cause of labyrinthitis (otitis interna)

A

viral

318
Q

common viruses that cause Labyrinthitis (otitis internia)

A

mumps, rebella, rubeola, and influenza

319
Q

ϖ Anyone who has nystagmus, vertigo, or labyrinthitis is at risk for _____

A

falling

320
Q

ϖ An abnormality in the inner ear fluid balance

ϖ More common in adults, onset generally seen when adults reach their 40s, but symptoms begin between ages 20 and 60

A

Meniere’s Disease

321
Q

Meniere’s Disease is caused by:

A

a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct

322
Q

sx of miniere’s disease

A

♣ Fluctuating , progressive sensorineural hearing loss
♣ Tinnitus or a roaring sound
♣ A feeling of pressure or fullness in the ear
♣ Episodic incapacitating vertigo, often accompanied by nausea and vomiting

323
Q

most troublesome complaint with meniere’s disease:

A

vertigo

324
Q

ϖ uses bone conduction to test lateralization of sound; detects for unilateral hearing loss
o Tunic fork placed on the patients head or forehead

A

weber test

325
Q

ϖ useful for distinguishing between conductive and sensorineural hearing loss; move vibrating tuning fork between two positions:
o 2 inches from opening of ear canal (for air conduction)
o Against the mastoid bone (for bone conduction)

A

Rinee test

326
Q

ϖ Abnormal electrical discharges from the brain
ϖ “Episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) that result from sudden excessive discharge from cerebral neurons”

A

seizure disorders

327
Q

3 main types of seizures:

A

generalized
partial
unknown

328
Q

generalized characteristics:

A

whole brain

whole body

329
Q

partial seizures:

A

1 side of brain

1 side of body

330
Q 
ϖ	only a finger or hand may shake
o	Only affects one side of the body
o	Mouth may jerk
o	Dizziness
o	Unintelligible talk
o	Unusual or unpleasant sights, sounds, odors, or tastes
A

simple partial seizures

331
Q

do simple partial seizures have LOC

A

NO

332
Q

ϖ patient remains motionless or moves automatically but inappropriately for time and place
o May experience excessive fear, anger, elation or irritability
o Patient does not remember episode when over

A

complex partial seizures

333
Q

do complex partial seizures have LOC

A

they may/may not

334
Q

ϖ ) involves whole brain; effects whole body

o Intense rigidity followed by alternating muscle relaxation & contraction

A

Generalized seizures (Grand mal)

335
Q

produced by simultaneous contractions of diaphragm and chest muscles—need to monitor respiratory status

in generalized grand mal seizures

A

o “Epileptic cry”

336
Q

characteristics for generalized grand mal seizure

A

chew their tongue

incontinent of urine and feces

337
Q

vital signs with seizures

A

tachy/bradycardia
HTN
ST segment depression (ischemia)

338
Q

Status epilepticus and repetitive seizures

can cause ?

A

pulmonary edema for up to 72hrs

339
Q

generalized grand mal seizures typically last

A

1-2 minutes

340
Q

• After 1-2min, convulsive movements begin to subside

pt relaxes and lies in deep coma, breathing noisily

A

postictal state

341
Q

what majorly leads to death during postictal state

A

respiratory

342
Q

biggest concern with any seizure

A

airway!!!

343
Q

triggers for seizures

A 
flashing lights
loud noises/music
stress
fatigue
alcohol consumption 
constipation
hypo/hyperventilation
menstruation
344
Q

o Occurrence of an ____—premonitory or warning sensation, which can be visual, auditory, or olfactory

A

aura

345
Q

♣ If patient starts seizing in the hall,

A

try to ease them to the ground—DON’T TRY TO HOLD THEM UP

346
Q

o involuntary motor activity, such as lip smacking or repeated swallowing during a seizure

A

automatisms

347
Q

o Incontinence of urine or stool (Usually indicator of _______ seizure)

A

generalized

348
Q

o How to Prevent complications after the seizure:

A 
side lying
HOB elevated
suction
oxygen
lowest position with 2-3 rails up and padded
349
Q

ϖ Group of syndromes characterized by unprovoked, recurring seizures
ϖ Defined as recurrent stereotypical seizures history of 2 or more seizure

A

epilepsy

350
Q

(Anything that causes seizures, can cause _____

A

epilepsy)

351
Q

risk factors for epilepsy

A

• Lesions of CNS (tumors)
• Meningitis or encephalitis (brain infections)
• Cerebral/brain tumors
• Stroke
• Anoxia
• Alcohol or drug abuse
• Toxin exposure—carbon monoxide, lead poisoning
• Degenerative diseases
• Fever; Infection (bacterial, viral, parasitic)
• Endocrine disorder (hypo/hyperglycemia)
• Birth defects, congenital malformations, genetics
Head injuries, brain trauma—

352
Q

main cause of epilepsy

A

head injuries/brain trauma

353
Q

ϖ 70% of all epileptic cases are considered ______ – cause UNKNOWN

A

idiopathic

354
Q

diagnosis of epilepsy

A

MRI
EEG
SPECT

355
Q

used to detect structural lesions such as focal abnormalities, cerebrovascular abnormalities, and cerebral degenerative changes

A

ϖ MRI

356
Q

o Additional tool that is sometimes used in the diagnostic workup—can detect abnormal electrical activity in brain
o Useful for identifying the epileptogenic zone so that the area in the brain giving rise the seizures can be removed surgically

A

SPECT

357
Q

ϖ Women with epilepsy often note and increase in seizure frequency during ____.

A

menses

358
Q

Effectiveness of contraceptives is decreased by ____-_____ medications

A

anti-seizure

359
Q

___ ____ is associated with long-term use of antiseizure medications

A

Bone loss

360
Q

surgical management for epilepsy

A

removal of tumor/abscess

vagal nerve stimulation

361
Q

o may be used—tricks body into not having seizures

♣ Generator may be implanted under the clavicle

♣ Device is connected to the vagus nerve in the cervical area where it delivers electrical signals to the brain to control and reduce seizure activity

A

vagal nerve stimulation

362
Q

vagal nerve stimulation doesn’t prevent seizure, it just ?

A

diminishes severity of it

363
Q

if a patient has epilepsy you can’t drive for _____ months

A

6 months

364
Q

education to send home with patient with epilepsy

A 
NO baths
NO excessive exercise
avoid extreme hot/cold temps
NO alcohol
need adequate sleep!!
365
Q

what labs should be drawn frequently with epilepsy

A

liver enzymes and CBC

366
Q

ϖ Series of generalized seizures that occur without full recovery of consciousness between attacks

A

STATUS EPILEPTICUS

367
Q

STATUS EPILEPTICUS o May be of any type –but usually ?

A

generalized tonic-clonic

368
Q

o Worried about repeated episodes of cerebral anoxia and edema with status epileptics because it can lead to….

A

irreversible and fatal brain damage

369
Q

wit STATUS EPILEPTICUS; May have pulmonary edema for up to ____ hours

A

72

370
Q

may occur if convulsive activity not halted with status epilepticus

A 
o	Hypoxia, 
acidosis, 
hypoglycemia, 
hyperthermia, 
exhaustion and 
brain damage
371
Q

main priority with status epilepticus

A

STOP the seizure with medication!!!!!

372
Q

ϖ One of the most common of all physical complaints

A

headaches

373
Q

classification of headaches:

A

primary

secondary

374
Q

not associated with a pathologic cause

A

o Primary HA

375
Q

ex of primary HA

A

migraine, cluster HA, tension HA

376
Q

have known etiology

A

Secondary HA

377
Q

ex of Secondary HA

A

o Meningitis, Tumors, Subarachnoid hemorrhage, Aneurysm, Stroke, Severe HTN, Head injuries, Brain surgery, Meds, Low BS

378
Q

• Complex symptoms characterized by periodic and recurrent attacks of severe HA lasting from 4-72 hours in adults

A

Migraine

379
Q

migraines are more common in?

A

women

380
Q

what causes migraines?

A

cerebral blood vessels narrowed and decreased blow flow to brain

381
Q

triggers for migraines

A

o rapid changes in blood glucose levels, menstrual cycles, depression, sleep deprivation, overuse of certain medications stress, emotional excitement, fatigue, alcohol intake, bright light stimulants, food high in tyramine (smoked foods), nitrates, or milk products

382
Q

4 phases of migraines

A

prodrome phase
aura phase
headache phase
recovery phase

383
Q

o Symptoms that occur hours to days before a migraine
♣ Depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea or constipation, N/V before

A

Prodrome Phase:

384
Q

♣ Visual disturbances (light flashes and bright spots) are most common and may be hemianopic (only half of the vision field)
♣ Other symptoms numbness and tingling of lips, face, or hands; mild confusion; slight weakness of extremity; drowsiness or dizziness

A

aura phase

385
Q

o Duration varies, ranges from 4-72hrs
♣ Vasodilation and decline in serotonin levels occur throbbing headache (unilateral in most) intensifies over several hours

A

headache phase

386
Q
  • Seen 5 times more frequently in men

* Similar to migraines but only last 45 minutes or so (few minutes to a few hours)

A

cluster headache

387
Q

cluster headaches incur in cluster periods for ___ or ____

A

weeks or months

388
Q

sx of cluster headaches

A

unilateral burning pain around eyes
facial edema
ptosis

389
Q
  • Tend to be chronic and less severe than migraine
  • Probably the most common type of headache
  • Produced by stress—Relaxation can help to treat
A

tension headache

390
Q

ϖ Common slowly progressing neurologic movement disorder that eventually leads to disability
o Affects men more than women
o Usually occurs after the age of 50

A

Parkinson’s Disease

391
Q

ϖ The degenerative or _______ form of Parkinson’s disease is the most common; there is also a secondary form with a known or suspected cause

A

idiopathic

392
Q

cause of parkinson’s is unknown, however there is a ____ component

A

genetic

393
Q

main problem with parkinson’s disease

A

not enough dopamine

394
Q

symptoms of parkinson’s:

TRAP

A

tremor
rigidity
akinesia/bradykinesia (slow movement)
postural instability

395
Q

Tremors in parkinson’s may manifest as?

A

pill rolling

396
Q

transient inability to perform active movement with parkinson’s

A

♣ Freezing phenomenon—

397
Q

with parkinson’s: Face becomes increasingly ____ and expressionless, and the frequency of blinking ______

A

masklike; decreases

398
Q

how to parkinson’s patients stand

A

head bent forward and walks with propulsive gait

399
Q

o Autonomic Symptoms of parkinson’s

A 
♣	Excessive and uncontrolled sweating 
♣	Paroxysmal Flushing
♣	Orthostatic hypotension 
♣	Gastric and urinary retention
♣	Constipation 
♣	Sexual dysfunction
400
Q

o Psychiatric Changes for parkinson’s

A

♣ Depression and anxiety
♣ Dementia (progressive mental deterioration)
♣ Delirium
♣ Auditory or visual hallucinations

401
Q

• surgical implantation of an electrode into the brain in either the globus pallidus or subthalamic nucleus.
o Stimulation of these areas may increase dopamine release or block anticholinergic release, thereby improving tremor and rigidity with parkinson’s

A

Deep Brain Stimulation (DBS

402
Q

♣ ongoing research

• Transplanting porcine neuronal cells, human fetal cells, and stem cells to replace degenerated striatal cells.

A

Neural Transplantation

403
Q

Chronic, progressive, heredity disease of the nervous system that results in progressive involuntary choreiform (chorea) movement and dementia

A

Huntington Disease

404
Q

: constant, rapid, jerky, involuntary, purposeless movements

A

o Chorea

405
Q

Chorea Affects walking, sleeping, EVERYTHING; so _____ is priority

A

safety

406
Q

usual age for Huntington’s

A

35-45

407
Q

sx of Huntington’s

A

chorea
impaired voluntary movement
intellectual decline
personality changes

408
Q

huntington’s Gait

A

becomes disorganized and ambulation eventually is impossible a wheelchair usually becomes necessary

409
Q

Huntington’s patient’s usually die within ___-___ years

A

10-20 years

410
Q

Huntington’s death is usually due to

A 
HF
pneumonia
infection
falling
choking
411
Q

diagnosis of Huntington’s

A

positive family history

genetic marker

412
Q

ϖ Neuronal (nerve) damage occurs primary in cerebral cortex and results in decreased brain size
o Progressive, irreversible, degenerative neurological disease characterized by gradual loss of cognitive function and disturbances in behavior and affect

A

ALZHEIMERS DISEASE

413
Q

ALZHEIMERS DISEASE can occurr in as young as ____ but not usually before ___ years old

A

40; 65

414
Q

Alzheimers disease is a Complex brain d/o caused by various factors:

A

Genetics, neurotransmitter changes, vascular abnormalities, stress hormones, circadian changes, head trauma, and presence of seizure disorders

415
Q

diagnosis of Alzheimers

A

autopsy brain biopsy shows a decrease in brain size

416
Q

o 1st signs of Alzheimers

A

Forgetfulness and memory loss (usually mistaken for normal signs of aging)

417
Q

other symptoms Alzheimers

A

o Lose ability to recognize familiar objects, places, or faces

Conversation becomes difficult due to cognitive decline

Personality changes

418
Q

o Death with Alzheimers results from complications of

A

pneumonia, dehydration, respiratory failure

419
Q

nursing management of Alzheimer’s

A

supporting cognitive function

providing physical safety

420
Q

increased confusion at night

seen with Alzheimer’s

A

♣ Sundown syndrome—

421
Q

ϖ Also known as “Lou Gehrig’s Disease” Professional baseball player who first had it

A

ALS

422
Q

ϖ Progressive degeneration of both upper and lower motor neurons

A

ALS

423
Q

diagnosis of ALS

A

o The prognosis generally is based on the area of CNS involvement and the speed with which the disease progresses

424
Q

chief symptom of ALS

A 
fatigue
progressive muscle weakness
cramps
fasciculation
incoordination
425
Q

twitching

A

fasciculation

426
Q

does cognitive function decline with ALS?

A

NOOO

427
Q

cure for ALS?

A

NONE

428
Q

preop cervical discectomy

A

evaluate labs

get baseline functioning (strength bilaterally, ROM)

429
Q

ND of cervical discectomy

A

acute pain
impaired physical mobility
deficient knowledge

430
Q

post op cervical discectomy

A

kept flat for 12-24 hours

431
Q

♣ If patient had bone fusion with bone removed from iliac crest, considerable pain pay be experienced at ___ ____

A

donor site

432
Q

a leak with Cervical Discectomy indicates

A

high risk for meningitis

433
Q

ϖ People who survived the polio epidemic of the 50’s are now developing new symptoms of weakness, fatigue, and musculoskeletal pain

A

post polio syndrome

434
Q

nursing interventions with post polio syndrome

A

management of fatigue
pain and progressive loss of muscle strength

pain meds

7th Semester (14 decks)

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