Exam 3

Question 1

Parkinson’s symptoms

Answer 1

3 Cardinal Symptoms (bradykinesia, resting tremor, rigidity)
postural instability
symptoms start unilaterally
pill rolling
eyelid blinking
no arm swinging when walking
dysphonia (soft voice)
micrgraphia (tiny handwriting)
loss of postural reflexes (head bowed, shoulders stooped)
dysphagia
slowed, slurred speech
masked facies (expressionless)
generalized weakness
constipation
orthostatic hypotension
flushing, diaphoresis
bladder problems
drooling

Question 2

Drugs that cause parkinsonism

Answer 2

Antipsychotics (haldol, lithium)
Antiemetics (compazine)
Reglan
Antihypertensives (reserpine, aldomet)
Methamphetamines

Question 3

Fall precautions

Answer 3

low bed
bed locked
fall bracelet
call light close
non-slippery shoes
open pathways
no throw rugs

Question 4

Aspiration precautions

Answer 4

HOB up before and after meals
lung sounds
watch for pocketing of food
thickened liquids
soft food

Question 5

Parkinson’s drugs

Answer 5

Sinemet (levadopa and carbidopa)

• -carbidopa inhibits peripheral conversion of levodopa so more can reach brain
• -complications (dyskinesia/involuntary movements, dystonia/muscle stiffening,on-off phenomenon, wearing off phenomenon/must give on time)

Question 6

Medication therapy for Parkinson’s

Answer 6

increase dopamine
decrease acetylcholine
–treat symptoms to maximize functional abilities while minimizing side effects

Question 7

Benign Prostatic Hypertrophy (BPH)

Answer 7

Voiding symptoms--
difficulty initiating stream
reduced force of the urinary stream
intermittency
dribbling
incomplete emptying
frequency
urgency
nocturia
could have renal complications

Question 8

Diagnosis of BPH and Prostate Cancer

Answer 8

Digital Rectal Exam (DRE)
--uniform, elastic, non-tender in BPH
--stony hard nodule in prostate cancer
Prostate Specific Antigen (PSA)
--elevated in both
--normal is 4-10ng/ml

Question 9

Conservative care for BPH

Answer 9

–Watch /wait to see if urinary difficulties
–Dietary changes (no alcohol, caffeine, no fluids at bedtime, avoid lrg amounts in short time
–Avoid meds that cause urinary retention (decongestants, anticholinergics)
–drugs
5 alpha-reductase inhibitors (proscar)–shrinks prostate, lowers level testicular androgens that stimulate prostate growth
Alpha-adrenergic receptor blocker (hytrin, cardura, flomax)–promote smooth muscle relaxation, side effects postural hypotension and dizziness

Question 10

Transurethral Resection of the Prostate (TURO) and continuous bladder irrigation (CBI)–Post-op care

Answer 10

Pre-op–check clotting factors (PT/INR/PTT)
Post-op–clots normal 24-36 hours
–bleeding common complication (hematuria), bladder spasms
–normal saline irrigation for 24 hours (flushes out clots)
–adjust irrigation fluid to maintain colorless or light pink drainage
–tape cath to leg
–increase oral fluids (2-3 L)
–watch for UTI
–avoid heavy lifting

Question 11

Hormonal therapy for Prostate cancer

Answer 11

Estrogens–inhibit release of LH (luteinizing hormone) from pituitary gland/stops hormone stimulation to the prostate
–Megace or Depo-Provera

Question 12

Emergency Care of SCI

Answer 12

Treat as SCI if Head (esp. face) or spine involved or fall from heights

• -maintain airway
• -immobilize on backboard w/cervical collar
• -prevent head flexion, rotation, or extension
• -solu medrol given w/in 8 hrs of SCI–high doses to stop edema–not for penetrating injuries
• -edema can extend up cord creating worse injury

Question 13

Cervical traction/Halo traction

Answer 13

• -used for high to mid cervical fractures w/out cord injury
• -requires pin care
• -Always continuous
• -assess for alignment
• -10-12 weeks
• -Do NOT raise HOB until ordered
• -walker
• -swivel chair
• -sponge bath
• -do not use bars to move patient
• -Do not lift >10lbs
• -low heeled shoes
• -button up shirts
• -straws for drinking

Question 14

C-collars

Answer 14

• -have 2 collars available
• -change collar while sitting or standing in front of mirror
• -snug but not tight (two finger)
• -should prevent nodding yes or no
• -complication=pressure ulcers

Question 15

Acute complications of SCI:
Spinal shock and hyperkalemia
(30 minutes to 6 weeks)

Answer 15

Shock–hypotension, bradycardia

• -warm dry extremities
• -inability to regulate temperature
• -areflexia below level of injury
• -no sensation, movement (flaccid)

Hyperkalemia–loss of K+ from paralyzed muscle

• -Kayexylate (preferred)
• -diuretics if tolerated by hypotension
• -insulin

Question 16

Autonomic dysreflexia symptoms/causes and treatments (Chronic)

Answer 16

Causes
--bladder or bowel distention
--tight dressings
--decubitus ulcers
--pregnancy
--anything that causes pain below legion
Symptoms
--sudden, severe hypertension (250/180)
--pounding headache
--bradycardia
--arterial dilation, flushed skin, sweating above T6
--nasal congestion
--cool skin /goose bumps below injury
Treatment
--SIT UP
--Monitor BP frequently
--look for cause and alleviate
--meds (vasodilators)--apresoline, procardia, NTG
Complications
--stroke
--MI
--Seizures
--renal or retinal hemorrhage

Question 17

Quadriplegia/Paraplegia

Answer 17

Quadriplegia
–C1 thru C8
–paralysis involving all four extremities
Paraplegia
–T1 thru L4
–paralysis involving only lower extremities

Question 18

Conservative treatment for back pain

Answer 18

Brief bed rest–2 days

• -exercises after acute pain subsides
• -ice/heat/massage
• -body mechanics
• -traction
• -meds (NSAIDs, analgesics, muscle relaxants, steroids

Question 19

Myelogram

Answer 19

Lumbar puncture /injection of contrast dye into subarachnoid space
Shows:  bony overgrowth, spinal cord tumor, spinal abscess, HNP or pinched nerve
Pre-procedure
--Allergies to dye
--BUN and creatinine
--NPO 4-8 hours
--D/C drugs that lower seizure threshold (metformin, phnergan, TCAs) and anticoagulants
Post-procedure
--force fluids
--low to semi-fowler position
--assess for voiding
--assess LE movement
--assess for spinal headache

Question 20

Post-op Laminectomy

Answer 20

• -Always log roll
• -Do not ambulate w/out order
• -Do not raise HOB w/out order
• -Always have draw sheet on bed
• -Report any neuro deficit
• -Avoid drugs that cause increased bleeding
• -No NSAIDs–want inflammation
• -antibiotics/pain management/stool softeners

Question 21

Cauda Equina Syndrome

Answer 21

Complete bilateral compression of lower lumbar and sacral roots–herniated out whole lower back
Causes sensory and motor loss below level of lesion
–flaccid lower extremeties, <DTRs, urinary/fecal incontinence or retention
SURGICAL EMERGENCY!!

Question 22

Trigeminal Neuralgia

Answer 22

Unilateral facial pain–burning, knifelike, including lips, upper or lower gums, cheek, forehead, or side of nose–can come and go
–bouts of pain provoked by minimal stimulation of trigger zone (eating, brushing teeth, talking)
Treatment–meds (antiepileptic/tegretol/tripeptal or antidepressants/amitriptyline or muscle relaxants/baclofen
–surgery (glycerol rhizotomy/chemical ablation or percutaneous rhizotomy/radiofrequency ablation or microvascular decompression/targeted radiation to site

Question 23

Peripheral Neuropathy

Answer 23

Symptoms
--muscle weakness
--stabbing, cutting, searing pain
--paresthesia (tingling, burning numbness)
--loss of sensation
--impaired reflexes
Meds
--antiepileptic-gabapentin
--antidepressant-nortriptyline
--opioids
Teaching
--smoking worsens
--protect extremities from burns, trauma, temp changes
--elastic stockings to facilitate venous return

Question 24

Bell’s Palsy

Answer 24

CN VII on one side of face
--facial weakness and paralysis
--full recovery in most pts after 6 months
Meds
--prednisone
--acyclovir
--valacyclovir
--famcyclovir
--doxycycline if lyme disease
Treatment
--moist heat, gentle massage, electrical stimulation of nerve, exercise therapy to facial muscles

Question 25

Botulism

Answer 25

``` Symptoms --N/V --abdominal cramping --neurologic (photophobia, ptosis, paralysis of extraocular muscles, blurred vision, dry mouth, difficulty swallowing, difficulty in convergence of eyes) --paralytic ileus --muscle weakness --seizures --respiratory problems Treatment --Botulinum antitoxin --GI tract purges (laxatives, enemas, gastric lavage with charcoal) ```

Question 26

Tetanus

Answer 26

--enters thru traumatic deep wound --stiffness in jaw or neck --fever --tonic convulsions --laryngeal and respiratory spasm causing apnea --overstimulation of sympathetic nervous system (diaphoresis, labile HTN, tachycardia, arrhythmias, hyperthermia Treatment --tetanus toxoid booster --control of spasms with deep sedations (valium, barbiturates --PCN or other antibiotics

Question 27

Risk factors for stroke

Answer 27

``` Heredity age male African American HTN obesity diabetes smoking hyperlipidemia heavy alcohol intake physical inactivity cocaine abuse carotid stenosis oral contraceptive use atrial fibrillation ```

Question 28

Health promotion to prevent stroke

Answer 28

``` Control BP (< 120/80) stop smoking exercies maintain ideal body weight decrease fat intake daily aspiring eat fish 2-3 times/week no oral contraceptives if smoke decrease alcohol intake adequate vitamin # and B decrease salt intake ```

Question 29

Stroke symptoms

Answer 29

sudden numbness or weakness in face, arm, leg difficulty understanding speech, loss of speech dizziness visual disturbances unexplained severe headache change in personality or mental status sudden loss of consciousness or syncope OLDER ADULTS--atypical--falling, failure to eat/drink, memory loss, urinary incontinence

Question 30

TIA (transient ischemic attack)

Answer 30

- -cerebral ischemia (w/out infarction) - -usually less than 1 hour - -most resolve but pt should go to ER b/c don't know if it will progress to stroke - -temporary loss of vision, hemiparesis, numbness, aphasia, tinnitus, vertigo, ataxia (difficulty walking)

Question 31

Ischemic stroke

Answer 31

thrombosis (stationary clot) or embolism (moving) - -tPA - -anticoagulants (heparin, coumadin, ASA, plavix) - -cautious treatment of HTN

Question 32

Hemorrhagic stroke

Answer 32

bleeding into brain due to ruptured vessel sudden onset 30-50 mLs=hemorrhage Causes --HTN, aneurysms, AV malformation, coagulation disorders, drugs, trauma, brain tumor, bleeding Symptoms --severe headache, N/V, slurred speech Complications --hydrocephalus, seizures, vasospasm, rebleeding --may require craniotomy to clip aneurysm or remove blood from brain

Question 33

tPA (Recombinant tissue plasminogen activator)

Answer 33

``` super clot buster--give w/in 3-4.5 hours of stroke (therapeutic window) --major adverse effect=bleeding Contraindications --taking anticoagulants abnormal coagulation (PTT) --BP > 185/110 --recent GI bleed --recent stroke, head trauma, or surgery w/in 14 days --pregnant ```

Question 34

Neglect Syndrome

Answer 34

Does not recognize one side of body - -break tasks down into one-step directions - -have pt complete one task at a time - -position objects w/in visual field - -cue pt to scan environment - -develop routine for self-care - occupational therapy

Question 35

Emergency management of stroke

Answer 35

- -Administer O2 - -Monitor VS (want MAP<130) - -assess baseline neurological status (GCS, --pupils, motor and sensory function) - -IV access with NS - -Labs (electrolytes-may have hyponatremia from excess ADH), glucose - -Seizure control and precautions - -assess gag reflex and institute feeding precautions - -at risk for IICP - -TIME IS BRAIN

Question 36

Stroke and immobility

Answer 36

``` trapeze side rails up roll on good arm and push away from bed non-slip slippers call for assistance transfer techniques unaffected side first out of bed PT ROM to prevent contractures proper positioning (support arms, footboard, splints, handrolls, lap boards) ```

Question 37

Functions of kidneys

Answer 37

``` maintain body fluid volume and composition filter waste products for elimation acid-base regulation regulate BP; thru hormone renin erythropoietin for RBC synthesis metabolize vitamin D to an active form ```

Question 38

renal terminology

Answer 38

oliguria--decreased urine output 100-400 mL/24 hrs anuria--no urination 2000 mL/24 hrs uremia--full-blown renal failure

Question 39

Diagnostic studies for urinary/renal

Answer 39

*Urinalysis--color, odor, turbidity (cloudiness) *Urine culture and sensitivity--analysis for number/type of organisms present and antibiotics that will work, must be clean catch serum creatinine--good indicator of kidney function, normal <1.3, SUPER impt test *BUN--indicates renal excretion of urea nitrogen *BUN/creatinine ratio--normal ratio (12:1)=kidney damage. Not normal=dehydration or poor renal perfusion *Creatinine clearance-24 hour collection, most indicative of kidney damage, NL 70-135 mL/min *KUB (kidneys, ureters, bladder)--plain film of abdomen, shows shape, size, and position of urinary tract *Bladder scan--portable ultrasound @bedside--shows how much urine in bladder *Cystoscopy--inspects interior of bladder with lighted scope, detects tumors, inflammation, prostate, strictures, structural irregularities *Renal ultrasound