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S3 1538 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Goal for aging family members with disability

A

Return home after learning to manage disability

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2
Q

What does managing disability in the elderly involve

A

ADLs/personal care
Meal prep
Physical therapy/exercise
Dr Appts

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3
Q

Each family is _

An illness in one member affects…

A

Unique

The other members

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4
Q

During time of illness provide… to PT

AND… to fam

A

Functional support

Emotional support

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5
Q

Antecedents of emotional support in a family

A

Trust
Safety/security
Boundary respect
Communication

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6
Q

When assisting elderly with goal or returning home, first…

A

Assess support system

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7
Q

When providing support to fam and patient give_ and be_

A

information

nonjudgmental

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8
Q

Info to give to PTs fam

A

As much as possible with PT consent

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9
Q

To build trust with PT and fam

A

Demonstrate use of equipment

Transfer and mobility skills

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10
Q

At home changes for disability may involve

A

Making a safe environment

Instructions on new diet or meds

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11
Q

Supportive info to provide elderly with disabilities

A

Where to get med supplies and DME (durable medical equipment)

Where to find support groups

Where to find recreation

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12
Q

What to evaluate for newborns with disabilities

A

Evaluate parents psych
Willingness to learn
What is the support system

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13
Q

Fantasy of family expansion

A

Real life is much more difficult and straining on family members

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14
Q

Adaptation to parenthood is

A

NOT easy

Have realistic expectation

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15
Q

Things to consider during family expansion

A

Partner struggles
Partner involvement
Sibling jealousy

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16
Q

Interventions for sibling rivalry

A

Expect and tolerate regression
Encourage discussion
Encourage participation in decisions
Make special time for siblings

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17
Q

First question when expanding fam

A

What is the support system

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18
Q

Teaching points for expanding family

A

Teach baby care
Teach breastfeeding
Provide info

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19
Q

Encourage mom/parents to

A

Provide interaction as much as possible

Praise efforts

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20
Q

Blended family

A

Significant other comes with baggage

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21
Q

Blended fam transition will take more

A

TIME

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22
Q

Children’s feelings in blended families

A

May feel jealous to stepparent

May feel disloyalty to biological parent

Competition/rivalry to other stepchildren

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23
Q

With blended families encourage

A

mutual respect

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24
Q

Blended families need _ and _ communication

A

Open

Honest

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25
Parenting responsibilities in blended families
Must be shared No good cop bad cop
26
What to assess for in blended families
Lack of support - overall or from partner to partner Poor attachment - too much or too little Negative behavior - retaliatory, attention seeking
27
In poor cases of blended families make
Referrals as needed
28
Major depressive disorder
2 or more weeks of sad mood or lack of interest in life most clear up in about 6 months
29
20% of major depressive disorders have
psychotic features
30
To be considered major depressive disorder, sad mood must be accompanied by... how many...
``` Anhedonia Weight change Sleep change Drop in energy Indecisiveness ``` Suicidal ideation At least 4 must be present for diagnosis
31
Neurotransmitters involved in Major depressive disorders
Norepinephrine and serotonin
32
Drug classes for Major depressive disorder
SSRIs - most MAOIs - sometimes Tricyclic antidepressants - seldom
33
Therapies for MDD (major depressive disorder)
Psychotherapy | Electroconvulsive therapy
34
Tricyclic antidepressant MOA How long to work
keep serotonin and norepinephrine available to the brain 6 weeks
35
TriCyclic Antidepressants Side effects TCA'S
Thrombocytopenia Cardiac - arrhythmia, MI, stroke Anticholinergic - tachycardia, urinary retention Seizures
36
Contraindications for Tricyclic Antis
Liver problems | Heart problems
37
MOAIs + Tricyclic Antis =
SEROTONIN SYNDROME
38
Nursing for MDD History Safety
Be patient, dont rush client Find out if they are suicidal, ask DIRECTLY, ask if they have a plan
39
Nursing and MDD Self care promotion with MDD
ADLs Nutrition/hydration Good sleep Do activities and hobbies
40
Giving activities to MDD clients
One at a time Do not overwhelm
41
Anticholinergic side effects of Tricyclic Antis
``` Urinary problems Eye problems - no if glaucoma Diabetes mellites Thyroid problems Heart problems Lung problems Kidney problems ```
42
Biggest problems with antidepressants
Suicide up to 2 weeks, because pt how has energy to act Not taking pills - collecting for a suicide attempt
43
MDD and therapeutic communication
Encourage to verbalize and describe emotions
44
MDD teaching with fam
Depression is an illness not a lack of willpower or motivation
45
Best MDD treatment combo
Meds + Therapy
46
MDD maintenance teaching for pt
Support groups Follow up on appts Instruct on med side effects - ID S/S of relapse and get immediate treatment
47
Because of how long antidepressants take to have an effect pt may
feel discouraged by lack of progress but have more energy to attempt suicide biggest problem during first 2 weeks
48
Electroconvulsive therapy 101
delivery of electrical impulses to brain = seizure thought to reset neurotransmitters
49
When to electro therapy
If antidepressants don't work | If actively suicidal
50
How much electro therapy before progress # best results # Normal routine #
Minimum of 6 treatments to see progress Max benefits at 12-15 treatments 3xWeek
51
1st line med for mood disorders like suicide and depression
SSRIs
52
MAOIs Monoamine oxidase inhibitors 101
MOA enzymes break down neurotransmitters These meds stop that, hence the inhibitors
53
MAOI dietary restrictions
Avoid tyramine Will ^ BP to point of stroke or death
54
What foods have tyramine
Aged cheese Fermented foods Beer Soy sauce
55
Normal side effect of MAOIs
``` dry mouth insomnia irritability high BP peeing problems ```
56
Serotonin syndrome S/S | MED EMERGENCY
Confusion Restlessness Sweating Muscle jerk movements
57
How long does it take for antidepressants to work but suicidal ideation happens at
3-4 weeks 2 weeks
58
Bipolar 101
episodes of depression and mania
59
Manic phase S/S
Euphoria Sleeplessness Poor judgement Rapid thoughts/actions/speech
60
Depressive phase of mania S/S
2 or more weeks of sad mood + ``` 4 of the depression symptom changes in: anhedonia weight sleep energy concentration ``` suicidal ideation
61
Manic onset | duration
rapid over a few days | a few weeks to months
62
Bipolar pts at most risk of psychosis
Adolescents
63
At what age does mania onset
teens to 30s
64
Bipolar mixed 101
alternates between manic depressive and normal
65
Bipolar I 101
Mostly mania some normal few depressive episodes
66
Bipolar II 101
Mostly depression some normal few manic episodes
67
Diagnosing mania
1 week minimum of altered behavior at least 3 of the following sleeplessness flight of ideas exaggerated self-esteem increased activity
68
Risky behaviors during mania
spending sprees sex with strangers impulsive investments
69
Go to med for bipolar
Antimanic - lithium Anticonvulsant - mood stabilizer, and protection against cycles Antipsychotics - if psychosis
70
Lithium 101
Partially or completely stops illness in 75% of pts Heavy on renal system
71
Is lithium metabolized
NO excreted in urine hence the kidney problems
72
Maintenance lithium level Treatment lithium level Toxic lithium level
0. 5-1.0 0. 8-1.4 1. 5 and up
73
Client and fam need to know S/S of _ with lithium
Toxicity thyroid renal
74
1.5-2 lithium toxicity S/S nursing intervention
N/V/D drowsiness slurred speech muscle weakness hold next dose, call Dr.
75
2-3 lithium toxicity S/S nursing interventions
``` Blurred vision Tinnitus Twitching Itching/rash Incontinence ``` Withhold all future doses, Call Dr. Prepare for gastric lavage Start IVs
76
3.0 and up lithium toxicity S/S Nursing interventions
``` Cardiac arrhythmia Vascular collapse Hypotension Seizures Coma ``` Excretion meds Hemodialysis Monitor resp circ immune and thyroid system
77
Lithium excretion meds
Aminophylline Mannitol Urea
78
Anticonvulsants used for mood stabilization
Gabapentin Carbamazepine Lamotrigine
79
Side effects of anticonvulsants
Drowsiness Sedation Weakness Fatigue
80
Nursing safety interventions for anticonvulsant meds
Get up slowly Monitor for hypotension Fall risk
81
Antipsychotics 101
block dopamine used in psychotic mania, psychotic depression and drug induced psychosis
82
Generations of antipsychotics
1st - haloperidol 2nd - quetiapine 3rd - aripiprazole 3rd has least side effects
83
side effects of antipsychotics
Dystonia - involuntary contractions Pseudoparkinsonism Dyskinesia - involuntary jerking Akathisia - can't be still
84
Psychotherapy is not useful for what bipolar cycle
mania
85
Nursing when bipolar pt is depressed
Get History Safety (suicide/harm prevention) ask the question Promote ADLs Hydration/nutrition Do activities Have good sleep
86
Manic comms interventions
Hist from fam or use short sessions Distance respect Use short sentences
87
Manic physical needs interventions
Finger foods high in calories and protein Rest and sleep Chanel movement into productive tasks
88
Manic psych interventions
Protect dignity Promote appropriate behavior Decrease stimuli
89
Fluid consumption when on lithium
2 Liters qd
90
Teach pt and fam that lithium therapy needs have them know
periodic blood work side effects and toxicity
91
Manic teaching to pt and fam
avoid risk taking behavior | recognize S/S or relapse
92
Risk factors for Postpartum depression
``` Poverty Lack of support Unplanned pregnancy Depression history Decrease in self esteem ``` Domestic violence
93
Post partum depression onset
6 weeks and up to 1 year KEY , feelings last longer than 2 WEEKS
94
Post partum Depression S/S
``` no appetite poor sleep emotional lability mood swings panic attacks ``` Depressed feelings Rejection of infant
95
Postpartum depression if untreated
becomes chronic depression
96
Father and Postpartum depression
increased depression risk in father
97
children of post partum depression moms have an increased risk for
emotional and behavioral problems sleep problems eating problems delays in development
98
Postpartum psychosis onset
2-3 week average 48h to 6months after birth
99
Post partum psychosis S/S
Major depression Disorientation Paranoia Hallucinations Thoughts of self harm or harming the baby
100
Postpartum psychosis is a medical _ needs
emergency immediate hospitalization
101
postpartum depression prevention during pregnancy
Monitor for S/S Do screening questionnaire Support groups Therapy Antidepressants if severe
102
Postpartum depression prevention after birth
Screenings Counseling Therapy Meds
103
Reluctance to do newborn care
Big sign of postpartum depression
104
Questions to ask for PostPartDep
Emotional state? Bonding? Hist of depression?
105
Emotional self care post partum
communicate feelings rest/ask for help take time for self see friends
106
Physical self care post partum
Exercise Eat well Bathe Dress
107
Breastfeeding and antidepressants
meds will go through milk not a big deal
108
Drugs of choice for post partum depression SSRIs
Sertraline Paroxetine Fluoxetine Citalopram
109
SSRIs 101
Serotonin helps in ``` behavior appetite sleep sex function ``` SSRIs keep more available
110
SSRI side effects
``` Sex problems N/V/D Insomnia Joint/muscle pain Headaches ```
111
Serotonin syndrome S/S
``` Agitation/restlessness ^HR ^BP ^Sweating Dilated pupils Muscle twitching Shivers, fever ```
112
Life threatening serotonin syndrome S/S
High fever seizures Irregular heartbeat Coma
113
St Johns' wort and serotonin
Increases level = serotonin syndrome
114
How long does it take for SSRIs to work
4-6 weeks
115
Discontinue SSRIs
DO NOT stop suddenly
116
SSRI withdrawal
Flu symptoms NVD Dizziness Fatigue
117
Suicide
Killing self
118
Risks for suicide
``` Psych disorders Chronic health issues PT hist Fam hist Environmental factors ```
119
If you suspect suicide
ASK THE QUESTION
120
Determine lethality of suicidal pt
Is there a plan? Are there means to execute? Where? Time/date? Anniversary?
121
Suicide preparations
Giving things away Being unnaturally happy - pt has a plan Talking to folks one last time Suicide notes
122
Safety and suicide nursing interventions
If lethality is low observe q10min If high = one on one supervision Contracts Assess support system Good attitude
123
Suicide contract
Have pt make a no-suicide or no-self harm contract
124
Nursing attitude toward suicidal pts
Be positive and non judgmental | Monitor your body language and facial expressions
125
Treatment for suicide
Psych Therapy Meds- SSRIs, MAOIs, Tryc Electrotherapy
126
Seizure 101
imbalance of electrical impulses rapidly firing without inhibition
127
Generalized vs partial seizure
Both hemispheres 1 hemisphere
128
Seizure causes
Fever CNS infection Hypoxia Hypoglycemia ETOH withdrawal Acid/base imbalance Tumor
129
Epilepsy
2 or more seizures more than 24h apart
130
Epilepsy can be caused by
Chronic condition TBI Stroke Meningitis
131
Seizures from fever or ETOH withdrawal are not considered _
epilepsy
132
4 stages of a seizure
Prodromal Aura Ictus Post ictus
133
Prodromal 101 S/S
occurs before event mood problems - depression, anxiety, anger
134
Aura 101 S/S
Seconds or minutes before event Altered vision, spots, dizziness, weird tastes, deja vu feeling
135
Ictus 101 S/S
Actual seizure - lasts 1-3 min
136
As soon as seizure starts start
Timing
137
Seizures lasting longer than 5 min
Status epilepticus | Med emergency
138
Post ictus 101 S/S
Recovery - can be immediate or up to days Tiredness, confusion, headaches Cant remember Injury to tongue/cheek
139
Tonic/Clonic (Gran mal) seizure 101
``` Most common + aura 1-3 min LOC High injury risk ```
140
Tonic phase
``` Body stiffens May groan or cry Bite mouth Foam at mouth Apnea ```
141
Clonic phase
Recurrent jerking Spasms Incontinence
142
Tonic seizure 101
only body stiffens LOC w/incrased muscle tone 30sec to minutes
143
Clonic seizure 101
Recurrent jerking Contraction and relaxation of muscle lasts severe minutes
144
Atonic seizure 101
Simply go limp and fall Followed by confusin
145
Seizure types recap
Tonic/clonic aka gran mal Tonic Clonic Atonic
146
``` Focal seizures (partial seizures) 2 types ```
Simple partial Complex partial
147
Simple partial seizure 101 S/S
Aware during seizure less than 2 min HR change Flushing Pain Offensive smell Can lead to Complex partial seizure
148
Complex partial seizure 101 S/S
Unaware of seizure Unusual movements - lip smacking, rubbing hands, picking at clothes Cant remember afterwards
149
Can pt recover from status epilepticus on their own Status epilepticus consequences
NO life threatening ``` Hypoxia to brain + Venous congestion = Irreversible fatal brain damage ```
150
Meds for Status epilepticus
Diazepam Valium Lorazepam Ativan GIVE IV will stop seizure immediately
151
Medications to stop convulsions with seizures
Barbiturate's Anticonvulsants Benzodiazepines
152
Barbituates to stop convulsions Side effects
Phenobarbital lowers BP and respirations, need blood levels causes fetal malformations
153
Anticonvulsants for seizure convulsions Side effects 2 of em
Phenytoin - bone marrow suppression, birth defects Valproic acid - liver heavy, WBC and platelets need monitoring
154
Benzodiazepines for convulsions Side effects
Diazepam/lorazepam FAST acting Drowsiness, build tolerance
155
2 Invasive treatments and diet for seizures
Surgery - remove area causing seizures Vagus nerve stimulator - stimulation prevents seizures Keto diet - 5% carbs, 30 % protein, 65% fat
156
First thing to assess for seizure risk factors
Hx of seizures Last med dose Last drug level
157
Seizure precaution
Padding of railing Fall precaution O2 and suction at bedside IV access
158
Bed position and clothing with seizures
Lowest position | Clothing should be non restrictive
159
Priority care during a seizure Over 5 min =
Prevent aspiration and trauma Don't put fingers in mouth Emergency
160
After seizure, to prevent aspiration with seizures
Keep pt on side | Make sure airway is patent
161
On awakening from seizure If confused If agitated
Reorient patient Gently guide to bed or chair Maintain distance but be close enough to prevent injury
162
Post seizure assessment and lab
VS Neuro check EEG Blood levels
163
Post seizure, document
Meds given | Characteristics noted
164
Status epilepticus nursing actions | Emergency
``` Activate Rapid Response Team IV - diazepam or lorazepam Airway - O2 or ET tube Labs - lytes, glucose, meds V/S and neuro checks ```
165
Education for seizure patients
Decrease stress Increase fluids Maintain normal glucose Ged blood work regularly
166
NOs of recreational activities for seizure patients
strobe lights loud noises alcohol recreational drugs
167
Brain tumor 101
Growth in brain
168
Brain tumor classification
Cell type | Location
169
Primary brain tumor
originates from cell within brain
170
Secondary brain turmo
Develops from outside brain
171
Brain tumors apply pressure resulting in
ICP
172
ICP S/S
``` Headache N/V Swelling of optic nerves Cerebral Edema Personality changes ```
173
Frontal lobe tumor changes
emotions/apathy inappropriate behaviors impulsiveness
174
Parietal lobe tumor changes
Decreased sensation or seizure on opposite side of body
175
Temporal lobe tumor changes
seizure on other side of body | Psych changes
176
Occipital lobe tumor changes
Loss of half the visual field on opposite side of tumor Visual hallucinations
177
Cerebral lobe tumor changes
ataxia gait problems falling toward side of lesion incoordination
178
Cerebellopontine angle tumor changes
tinnitus vertigo deafness numbness and tingling in face face paralysis motor problems
179
Incidents of brain tumors increase with
AGE
180
Early S/S of intracranial tumor with age
are often overlooked or misdiagnosed as normal cognitive decline
181
Most common brain tumor S/S in elderly
Personality Confusion Speech Gait
182
Diagnosing brain tumore
CT w/contrast MRI PET Lumbar puncture EEG Biopsy
183
Brain tumor meds pain edema
Analgesics Corticosteroids
184
Brain tumor meds seizures vomiting
Anticonvulsants Antiemetics
185
Decreasing ICP with brain tumors
Diuretic Mannitol
186
Surgery for brain tumore
craniotomy
187
Radiation and chemo for brain tumors
Radiation - external and brachytherapy available Chemo - with or without radiation available
188
Nursing care for brain tumors
Seizure precaution Headaches and nausea Neuro deficit - poor swallowing, semisoft diet
189
Normal ICP monitoring pressure
5-15mmHg
190
S/S of ICP
``` NV Headache LOC Pinpoint pupils Altered breathing Abnormal posture - decerebrate or decorticate or flaccid ```
191
Preventing ICP
``` Elevate HOB Maintain head and neck neutral DONT Valsalva Maintain body temp Maintain fluid balance Avoid noxious stimuli ```
192
Corticosteroids for ICP
hyperglycemia and lyte imbalance monitor blood sugar push fluids
193
Assist patient with brain tumors in
Self care Walking Injury prevention
194
Assess brain tumor pts
Muscle strength | Eye problems
195
Glasgow coma scale
Neuro assessment
196
Magic number on Glasgow coma scale
8 below 70% mortality above 90% survival
197
what interferes with doing glasgow scale
intubation
198
Glasgow coma scale 8= 9-12= above 13=
severe head injury moderate head injury minor head injury
199
Hydrocephalus 101
Abnormal accumulation of cerebrospinal fluid in ventricles water on the brain
200
Types of hydrocephalus
Communicating (non-obstructive) Non communicationg (obstructive)
201
Normal pressure hydrocephalus
communicating non obstructive most common in elderly
202
Infant and hydrocephaly S/S
High pitched cry Poor feeding Vomiting LOC
203
Infants and hydrocephaly head alterations
Increased circumference of head Wide open bulging fontanels without pulse Head will feel tense and full
204
Children with hydrocephaly S/S
same as infants plus Headache complaints Visual problems Physical and cognitive changes
205
Adult hydrocephaly manifestations
``` Eye problems Gait problems Mild dementia Personality changes Seizures ```
206
Diagnostics for hydrocephaly
Skull xray CT MRI
207
EVD | External ventricular device
pulls liquid out of brain via machine
208
ETV | Endoscopic third Ventriculostomy
pulls liquid out of brain via device
209
VP shunt | Ventriculoperitoneal shunt
Shunt from ventricle to peritoneal space need to be changed over time to accommodate growth
210
Hydrocephaly head assessment
Inspect Palpate Percuss
211
Infection S/S with VP shunt
elevated vitals decreased responsiveness seizures vomit local inflammation along shunt
212
Malfunction S/S with VP shunt
Vomit Drowsiness Headache Unequal pupils Basically ICP
213
Early Signs of ICP
Headache Projectile vomit Blurred vision, delayed pupils, double vision, setting sun Seizures
214
Vitals and ICP | ON test
Decrease in pulse and resp Increase in BP or pulse pressure
215
Infants and ICP | physical changes
Bulging fontanels Wide sutures Increased circumference Dilated veins
216
Late signs of ICP
``` LOC Decreased motor/sensory response Bradycardia Chain-stokes resp Dilated fixed pupils ```
217
Body posturing and late signs of ICP
Decerebrate or decorticate posturing
218
Teaching parent about hydrocephalus and kids
``` Recognize complications early Developmental disabilities will be present Have realistic goal Financial strain Therapeutic listening ```
219
TBI 101 | Traumatic brain injury
skull or brain injury serious enough to interfere with normal function
220
Primary vs secondary TBI
immediate damage due to impact delayed damage due to lack of nutrition of perfusion
221
Mild Mod Severe TBI
Mild - LOC less than 15 min, disoriented and confused Mod - LOC greater than 15 min, days or weeks confused Severe - LOC greater than 6H
222
Brain injury types
Contusion Diffuse axonal injury Intracranial hemorrhage Concussion - mild TBI
223
Contusion TBI 101
Damage in specific area LOC stupor confusion edema and hemorrhage risk peaks at 18-36h possible ICP
224
Diffuse axonal injury TBI 101
widespread injury tearing, shearing or axon fibers Immediate coma longer than 6H
225
Decorticate posture
feet/arms toward body cerebral damage
226
Decerebrate
feet and arms away from body brain stem damage
227
Hemorrhage location terms Extra axial - Epidural - Subdural - Subarachnoid -
outside brain tissue above dura below dura below arachnoid space
228
Hemorrhage location terms Intra axial - Intracerebral - Intraventricular -
Inside brain tissue Within brain Within ventricles
229
Expanding TBI hematoma S/S
Brief LOC Lucid intervals ICP Restless Confused Then Coma
230
TBI hematoma Treatment
Craniotomy - remove clot or bleeding
231
Elderly TBI injuries are most likely in what area
subdural
232
Mild vs classic concussion
mild - no loc, brief confusion classic - loc less than 5 min, amnesia, mind problems (NV, HA, memory etc.)
233
What to monitor for TBIs
``` LOC HA NV Abnormal pupils Slurred speech Arm/leg numbness or weakness ``` red flags indicating further action
234
Chronic traumatic encephalopathy | CTE
Happens due to multiple concussions brain degeneration
235
CTE S/S
impulsiveness poor judgement memory loss emotional lability substance abuse suicidal thoughts
236
Post concussion syndrome 101 duration S/S
10 days to 3 months Cognitive issues Behavioral issues NVH visual and hearing sensitivity
237
Post concussion patient teaching
Problems will start with going back to work or school Avoid activities that can result in another concussion Rest brain
238
Skull fracture 101 S/S
persistent localized pain indicates most common is basal racoon eyes, battel signs, CSF leakage from ears and nose
239
Diagnostics for TBIs
CT scan without contrast Xray of head and neck MRI Angiography
240
Glasgow coma scale categories
Eye opening - 4 point max Verbal response - 5 point max Motor response - 6 point max
241
Coma on Glasgow scale Severe head injury on scale moderate injury on scale mild injury on scale
3 8 or less 9-12 13-15
242
TBI interventions
``` HOB at 30 degrees Patent airway O2 Ventilation Suction ```
243
Monitoring for TBI
``` neuro function cerebral perfusion lytes nutrition temp ``` skin integrity
244
Late ICP finding, cushings triad
Hypertension Bradycardia Bradypnea
245
Cushings triad leads to
Seizures Increased ICP-herniation-death
246
Devoices to monitor ICP normal range
Intraventricular cath Subarachnoid screw Epidural sensor 5-15mmHg
247
Managing ICP
``` Oxygenation HOB 30 degrees Head and neck in neutral alignment Prevent valsalva Body temp Fluid balance ```
248
Normal cerebral perfusion pressure
50-70mmHg
249
TBI Meds
Diuretic - mannitol - decrease pressure Steroid - decrease inflammation Anticonvulsant - prevent seizure Benzo - sedation, (makes it hard to do Glasgow) NS - isotonic fluid
250
TBI supportive measures
Ventilator for O2 F/E balance Nutrition support Manage pain/anxiety
251
Brain death 3 cardinal signs
complete loss of function Coma Absence of brainstem reflex Apnea
252
Confirming brain death tests
EEG | CBF - cerebral brain flow
253
Organ donation and fam
Fam can overturn decision if no documentation is complete fam needs to be informed
254
OPO/TOSA what they do
Oran Procurement Organization They will talk with family
255
Keeping body viable for organ donation rule of 100s ON TEST
PaO2 100mmHg Urine output 100ml per hour Systolic BP at 110mmHg Temp at about 100
256
2 types of stroke
Ischemic - occlusion by thrombus or emboli Hemorrhagic - bleeding into brain
257
FAST stroke S/S
Face - uneven Arms - hanging, uncontrolled Speech - slurred Time - call 911 now
258
Stroke is associated with what heart condition
Afib
259
tPA treats what stroke
Ischemic
260
tPA time frames
given within 3h of stroke | given within 60min of getting to hospital
261
Ischemic stroke motor body problems S/S
numbness weakness on one side balance and walking problems hemiparesis, hemiplegia apraxia
262
Ischemic stroke motor face problems S/S
Dysarthria - speech problems Dysphasia - swallowing problems Aphasia - understanding speech x2
263
Ischemic stroke cognitive problems S/S
Mental status changes Headaches Agnosia - perception problems Memory loss
264
Left hemisphere stoke will present as S/S
right side problems Aphasia - speech and understanding Intellectual disability Slow cautious behavior
265
Right hemisphere stroke will present as S/S
Left side problems Spatial perception problems Distractibility Poor judgement, impulsivity
266
TIA | Transient ischemic attack
temporary attack lasts 1-2h less than 24 Warning of an impending stroke
267
Healthy lifestyle and stroke prevention
No smoking Physical activity Healthy weight and diet Modest alcohol consumption
268
Modifiable risk factors to prevent stroke
``` Hypertension AFIB, stenosis Cholesterol Obesity Sleep apnea Oral contraceptive use ``` smoking and drinking
269
Treatment of stroke
CT scan within 25min - determines ischemic or hemorrhagic 12 lead EKG and carotid ultrasound MRI or brain and neck tPA
270
What does tPA do
dissolve clots
271
regulations for admining tPA
2 IV sites 10% push 90% pump V/S q15m for 2h, 30min for 6h, 1h for 24h BP maintained ABOVE 180/105
272
Side effects of tPA
BLEEDING
273
what to monitor with tPA patients
Airway Circulation Neuro
274
Stroke and carotid endartherectomy
surgery to remove plaque from artery
275
To prevent stroke, Afib is managed by
Anticoagulant therapy A fib makes pumping slow, so clotting risk goes up
276
PREVENTION Managing cholesterol with stroke Managing clotting with stroke Managing BP with stroke
Statins Antiplatelet Antihypertensive
277
Hemorrhagic stroke 101
brain metabolism disrupted by blood ICP Secondary Ischemia from vasoconstriction due to pressure
278
Hemorrhagic stroke S/S
Same as Ischemic plus HA sudden LOC Vomiting BACK AND NECK PAIN
279
Diagnosing hemorrhagic stroke
CT, MRI Cerebral angiography Toxicology if pt under 40
280
Stroke can lead to what complications
Cerebral hypoxia Vasospasms ICP Seizures Hydrocephalus Hypertension Rebleeding
281
Managing hemorrhagic stroke
sedation and rest surg-relieve bleeding prothrombin to stop bleeding dilantin - stroke prevention Analgesics/antipyretics
282
promote circulation with strokes via what device
Pneumatic compression devices
283
Monitoring during acute phase of stroke
``` vitals O2 neuro motor pupils BP I&O/bleeding ```
284
Best hospital environment for stroke patients
``` Nonstimulating Restrict fam HOB at 30 No valsalva Compression stockings ``` Decrease anxiety
285
Post acute phase nursing for stroke patients
Mental status Motor status Skin integrity Activity tolerance
286
Most brain patients will be bed ridden, be sure to check
skin integrity
287
Encouraging self care post stroke
Realistic goals Personal hygiene Dont neglect affected side Use assistive devices
288
Diet and nutrition interventions after stoke
speech therapy Sit upright Chin tuck swallow method THICKENED LIQUIDS or PUREE
289
Bowel and bladder interventions post stroke
Voiding schedule Fiber + Fluids Bowel and bladder retraining
290
Education post stroke
Med education Safety measures Exercise Recreation
291
Meningitis 101
Inflammation of brain
292
2 major bacteria that cause meningitis
Nisseria meningitides | Streptococcus pneumoniae
293
Primary prevention of meningitis
Meningococcal Vaccine initial at 11-12y booster at 16 given to individual living closely together
294
Meningitis vaccine for kids
HIB b 4 shots 2m4m6m 12-15m
295
Meningitis vaccine for immunocompromised adults or over 65
Pneumococcal polysaccharide vaccine PPSV23 given q5years
296
Meningitis S/S
SEVERE HA fever/chills N/V disorientation restlessness photophobia rash
297
Nuchal rigidity
Stiff neck | Indicates meningitis
298
Kernig's sign Brudzinski's sign
Pain with extension from flexed position Pain with knee/hip flexion + neck flexion
299
Infant S/S of meningitis
poor feeding weak cry vomiting rash
300
Meningitis babies will be more consolable when
lying still as opposed to being held
301
Opisthotonic position
Baby arches back | Meningitis
302
Diagnosing Meningitis
MRI/CT Lumbar puncture - CSF CBC - W^ cultures
303
Parkinsons 101
Progressive debilitates motor function destruction of dopamine cells in brain
304
Carginal signs of Parkinsons ON test
Tremors Rigidity Bradykinesia Postural changes
305
tremors with parkinsons
Shaking pill rolling starts with fingers and moves to hands may disappear with purposeful movement or sleep
306
muscle rigidity with parkinsons
cogwheel movement - jerking kinda like a clock tick as it progresses, pt wont be able to move face
307
bradykinesia with parkinsons
slowing of movement muscles issue, messages come but movement is delayed Freezing - pt will literally stop in place because they can't move
308
Postural instability with parkinsons
Late sign stooped posture shuffling gate
309
Diagnosing parkinsons
Based on presence 2 of the 4 cardinal symptoms Positive response to levodopa trial
310
Cure for parkinsons
none
311
Antiparkinsonian meds
Levodopa - converted to dopamine by body, symptom relief Carbidopa - added to levodopa, keeps it available for longer
312
Levodopa therapy is most effective at after that
1-2y effectiveness drops adverse effects become severe Dyskinesia
313
Biggest side effect to levodopa
Dyskinesia Uncontrolled involuntary movement of head body and extremities chewing and smacking movements head bobbing
314
Perkinsons and deep brain stimulation
implant of electrode into brain pulse increases dopamine release
315
criteria for getting deep brain stimulation surgery with parinsons
having disease for 5 years disability due to tremors levodopa causes dyskinesia
316
Parkinsons nursing care for motion
Mobility - daily exercise, massages Walking training Physical therapy
317
Parkinsons nursing for self care
assistive devices bedside rails at home bowel training fiber+fluids
318
Nutrition and diet with parkinsons
CHOKING is common Sit up right THICK LIQUID diet monitor weight weekly
319
Communication from nurse to parkinsons
speak slowly face listener annunciate
320
Communication from parkinsons pt
Encourage deep breaths before speech | Use tool or images
321
Home education for parkinsons patients
Plan activities for pt DONT just do things for them pt and fam need to know stages and severity
322
Postpartum depression scales
Edinburgh scale and PDSS self screen

S3 1538 (15 decks)

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