exam 5- nuero Flashcards

(179 cards)

1
Q

Frontal lobe- controls

s
s
m c

A

speech

, smell,

motor control

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2
Q

Parietal lobe- t x2

A

taste and touch

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3
Q

Temporal lobe controls

h
f r

A

hearing

facial recognition

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4
Q

Occipital lobe controls what

A

vision

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5
Q

Cerebellum controls what

A
  • coordination
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6
Q

difference between Consciousness and Unconsciousness

Altered States of Consciousness

A

Consciousness: responsiveness to sensory stimuli (alertness and cognitive power)

Unconsciousness: inability of the brain to respond to stimuli

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7
Q

confusion

delirium

lethargic

Altered States of Consciousness

A

Confusion – unable to think clearly or rapidly

Delirium- sudden and more severe change in loc

Lethargic-lacking energy

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8
Q

stupor

coma

Altered States of Consciousness

A

Stupor – generally unresponsive, may be breifly aroused by painful or repeative stimuli

Coma -unarousable

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9
Q

etiology of Altered Consciousness

all these may cause increased what/ decreased what

A

trauma,
hypoxia,
infection,
poisoning,
seizures,
endocrine or metabolic disturbances,
electrolyte or acid-base imbalance,
CNS pathology,
congenital structural defect

all may cause increased cranial pressure (ICP) and decreased cerebral perfusion.

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10
Q

manifestations of Altered Consciousness

what decline
what posture

A

Decline in level of consciousness

Decorticate posturing
Decerebrate posturing

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11
Q

Altered Consciousness pneumonic

AEIOU-

A

alchohol,

epilepsy,

insulin,

opium,

uremia

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12
Q

Altered consounsess pneumonic

TIPSS-

A

tumor,

injury,

psyhiactric,

stroke,

sepsis

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13
Q

diagnostics for altered consciousness

c s
m
e
d s
what puncture

A

Ct scan,

mri,

eeg,

dopler studies,

lumbar puncture,

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14
Q

labs for altered consciousness

g
a
what function
t
serum

A

glucose,

abg,

liver function,

toxicology

, serum electrolytes, serum osmlalrity

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15
Q

what is priority in altered consciousness

identify
preserve
protect

A

identify cause

preserve brain function

protect ABC

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16
Q

tx for altered consciousness

put in what
give what

A

put in Cath

isotonic fluids

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17
Q

tx for altered consciousness

what for hypoglycemia
what for hyperglycemia
what for overdose
what for hyponatramia
what for meningitis

A

50% dextrose for hypoglycemia

insulin for hyperglycemia

naloxone for overdose

diuretics for hyponatramia

antibiotics for meningitis

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18
Q

signs that there is brain injury

Decoricate
Deceberate

A

Decoricate- posture is in the core of body

Deceberate posture is at the sude

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19
Q

Respirations x2

Assessment of Deteriorating Brain Function

A

Cheyne-stokes

Hyperventilation

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20
Q

Arousal / cognition

as impairment to the brain progreses, what is needed to get responses from pt

Assessment of Deteriorating Brain Function

A

higher intensity stimuli is required to elecite a response from pt

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21
Q

Motor responses–

pt may go from what to what

Assessment of Deteriorating Brain Function

A

pt may go from being able to repsond( squeeze hand)

to only being able to grimace and less purposeful movmements

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22
Q

Coma states / brain death-

what is persistent vegetative state

what is locked in syndrome

what is brain death

Assessment of Deteriorating Brain Function

A

Persistent vegetative state- permanent condition of complete unawareness of self/environment

Locked-in syndrome- pt is aware of surroundings, but cannot communicate

Brain death- irreversible damage to brain tissue

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23
Q

Generalized criteria Assessment of brain death-

c w/ no what
what repsiration
what pupils
what eyes
what brain waves

A

Coma w/ no motor/reflex movements

No spontaneous respirations

Pupils fixed and dilated

Doll’s eyes and no oculovestibular reflex

No brain waves (EEG)

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24
Q

how long do manifestations need to be present for for breath death

how long after coma/apnea

A

These have been present for at least 30 minutes to 1 hour

6 hours after coma/apnea

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25
Neurologic assessment (brief) loc-> vs-> pupils-> strength-> sensation->
1. LOC- ask about time and place-ax0x 2. VS- take vitals 3. Pupils- assess perlla 4. Strength- asses againts resistance/ grips 5. Sensation-assess how well they feel sensations and things
26
Olfactory 1- how assess
test ability to smell
27
Optic-2- how assess
assess Snellen eye chart
28
Oculamtoror3, trochlear4 and abducens6- follow assess
follow h assess perrla
29
Trigeminal5 how assess
-test ability to feel sensation on face
30
Facial7- how assess
smile frown raise eyebrows
31
Acoustic8- how assess
assess hearing
32
Glossopharangyeal 9 and vagus 10- how assess
assess gag reflex
33
Spinal nerve11- how assess
shrug shoulders
34
Hypoglossal 12- how to assess
stick out toungue
35
glascow coma EVM what what number need interventions
Eye opening Verbal response Motor response Want the highest number possible- under 7 may need Interventions
36
what interventions if low clascow coma scale what managment p
airway managemnt pain
37
early Signs of increased ICP (Pediatric) h what changes / d what vs
headache, visual changes, n/v(especially in kids), dizziness, changes in vs
38
late signs of increased ICP in PEDS c t what pupils r changes x2
Cushing’s Triad BP (increased systolic) Breathing - irregular Bradycardia Also nonreactive pupils restlessness, changes in loc, changes in motor repsonses
39
manamgent of pediatric LOC first do what then check what
figure out what caused it Check brief neuro, LOC & Glasgow Coma Scale
40
diagnostics of pediatric altered LOC L L p e c/m
Labs, Lumbar puncture, EEG, CT/MRI
41
interventions for pediatric altered loc check give assisted correct what maintain what
Check BG, give O2, assisted ventilation, correct imbalances, maintain cerebral perfusion,
42
potential meds for pediatric altered loc d I n t a
dextrose, ?insulin, narcan, thiamine, ?antibiotics)
43
Cerebral Edema Increased Intracranial Pressure (IICP)
Increase of brain fluids
44
Hydrocephalus Increased Intracranial Pressure (IICP)
Overproduction or abnormal reabsorption of CSF
45
Brain Herniation Increased Intracranial Pressure (IICP)
Displacement of brain tissue
46
what icp is normal what icp requires interventions Increased Intracranial Pressure (IICP)
Normal icp is around 5-10. people become symtoatic around 12 12-15 require interventions
47
manifestations of increased intracranial pressure what decreases what posture what vision c t what temp
LOC decreases (headahce / vomiting) Hemiplegia / posturing Altered vision / no PERRLA cushings triad hyperthermia
48
increased intracranial pressure whaat is Cushing’s triad b b b
high bp bradycardia irregular breathing
49
Diagnosis:_ c m icp what Increased Intracranial Pressure (IICP)
ct, mri , icp transducer_____
50
Medications: what to decrease fluid what to induce coma what for hyperthermia what for seizure f anti what what for gi Increased Intracranial Pressure (IICP)
osmotic dieurtic (mannitol), maybe loop dierteiic, potential induction of coma(propofol), hyperthermia (acetaminophen), seizures- diazapem, fluids, antihypertensives, ppi(pantoprazole)
51
Earliest sign of increased ICP is change in what Increased Intracranial Pressure (IICP)
in LOC & respirations!
52
Increased Intracranial Pressure (IICP)- medical treatments s what monitoring-watch for what m v
surgery icp monitoring-watch for infection mechanical ventilation
53
Increased Intracranial Pressure (IICP) Goal: preserve what prevent what
Preserve brain function prevent secondary brain damage
54
Increased Intracranial Pressure (IICP)-Interventions: what hob what movement no what
Increase HOB Minimal mvmt / no head rotation avoid coughing
55
Increased Intracranial Pressure (IICP)-Interventions: empty what avoid what r
Keep bladder empty avoid constipation Rest
56
Increased Intracranial Pressure (IICP)-Interventions: monitor what limit what for eyes
Monitor fluids (not too much) limit visitors Eye patch/drops maybe if one eye is open
57
seizures what are they results in what
Abnormal electrical activity in the brain --> results in abrupt/temporary altered LOC
58
seizure interventions loosen what turn where nothing where what if avaialve protect what never do what-
Loosen clothing around neck Turn pt. on side Nothing in the mouth O2, if available Protect head- to protect from floor Never move pt, always move objects
59
seizures medication a treat what
anticonvulsants treat potential causes
60
seizure aura
they can tell they are about to have a seizure
61
what is ischemic stroke
TIA Thrombotic Lacunar infarct Cardiogenic embolic
62
what is hemorrhagic stroke
brain bleeding from traumatic experience
63
what puts pt at risk for Hemorrhagic stroke what bp d/ what lipid s/ a use what lipids what heart disease
htn, diabetes/ Hyperlipedmia, smoking/ alchohol, a fib w anticaulation management
64
how to tell difference between strokes
ct scan
65
how to treat ischemic stroke hemorrhagic stroke
ischemic- tpa w/in 3 hrs and anticaogs after hemorrhagic- surgery
66
stroke manifestations loss of what inability loss of what
loss of visual field inability to identify loss of consciousness
67
Traumatic brain injury (TBI) who's at risk what need to get
Most at risk  males, ages 15-24 and 75+ Want to get all information// details about whats going on
68
Traumatic brain injury (TBI) Contact phenomena-
head is struck by a moving object
69
Acceleration-deceleration- Traumatic brain injury (TBI)- coup contrecoup coup-contrecoup
Coup-direct- head on steering wheel Contrecoup- indirect- head going back Coup-contrecoup- had going back and forth
70
Rotational injury Traumatic brain injury (TBI)
-brain rotates within the skull
71
never put ng until you know what if suspected tbi-> Traumatic brain injury (TBI)
Never put an ng in until you know where the brain injury is If suspected tbi- check ears for CSF potentially coming out
72
If checking for skull fracture, look for r e b s Traumatic brain injury (TBI)
racoon eyes-> (bruises on eyes) battle sign-> bruising behind ears
73
Contusion-Traumatic brain injury (TBI)-Manifestations: LOC how long a d/c/d what vision
LOC > 5 minutes Amnesia Drowsiness, confusion, dizziness Diplopia, blurred vision
74
Post concussion syndrome persistent what d I impaired what Contusion-Traumatic brain injury (TBI)-
Persistent headache Dizziness Irritable and insomnia Impaired memory / concentration / learning problems
75
decrease what Contusion-Traumatic brain injury (TBI)
Decrrease environmental stimulation- no reading , no screens, want them just sitting bored, no contact sports- LET BRAIN HEAL
76
TBI-Epidural Hematoma (blood between skull and brain protection layer) rapid what h v what pupils
Rapid decline in loc, headache, vomiting, fixed, dilated pupil on same side (ipsilateral)
77
TBI-Epidural Hematoma (blood between skull and brain protection layer) how fast does it develop needs what
Develop rapidly- from traumatic injury Need immediate interventions!-life threatening-arterial bleed
78
TBI-Subdural Hematoma (inner layer of skull and brain unilateral enlargement of what
Unilateral headache, enlargement of ipsilateral pupil
79
Subdural Hematoma (inner layer of skull and brain how fast does it develop
Can be chronic and develop slowly- venous bleed
80
TBI-Intracerebral Hematoma- where is it is it deadly
directly in brain tissue- anuerysm- may turn into death qucikly
81
interventions- what for ABC what kind of fluids o-where TBI- Epidural Hematoma Subdural Hematoma Intracerebral Hematoma
hypertonic fluids oxygen-et tube
82
interventions- what meds o d anti s TBI-Epidural Hematoma Subdural Hematoma Intracerebral Hematoma
Osmotic diuretic(mannitol) anticonvulsants sedatives
83
interventions- keep how no what monitor what TBI-Epidural Hematoma Subdural Hematoma Intracerebral Hematoma
keep cooler no nasal suctioning monitor icp
84
Brain Tumor manifestations c change in hwat h / what vision loss of what
confusion, change in loc, headache, n/v, change in vision, loss of balance
85
brain tumor tx c s
chemo surgery(burr hole/cranionomy)
86
Suggestions to Decrease Incidence of Migraine Headaches wake up when eat when no what reduce what practice what
Wake up at the same time every morning. Eat your meals and exercise on a regular schedule. No smoking or caffeine after 3:00 p.m. Reduce or eliminate red wine, cheese, alcohol, chocolate, and caffeine. Practice relaxation techniques, such as yoga, meditation, or biofeedback.
87
Reyes syndrome -what is it
Acute encephalopathy caused by a toxic, injury, inflammatory or anoxic insult
88
reyes syndrome develops after what associated w what
a mild viral illness (varicella/influenza) Association with use of ASA for a mild flu like illness
89
reyes syndrome manifestations change in what high what level what glucose what organ function
Change in loc, high ammonia levels, high glucose, high lft,
90
Hydrocephalus - imbalance of what
Imbalance between the production and absorption of cerebrospinal fluid
91
Hydrocephalus-Manifestations increased what x2
: increased head circumference increased icp,
92
Hydrocephalus-Diagnosis p e c m
- physical exam, ct, mri,
93
Hydrocephalus Tx
- vp and va shunt,
94
vp shunt - watch for what may need what
Watch for infections, may need to be replaced as growth happens,
95
Myelodysplasia (Spina Bifida) what is it Neuro Tube defects:
Defect in one or more vertebrae through which spinal cord contents can protrude
96
Myelodysplasia (Spina Bifida) manifestation put infant where need to be born how Neuro Tube defects:
Sac like protrusion place infant prone to avoid tension on sac born via c section
97
Myelodysplasia (Spina Bifida) Dx: when c/ m Neuro Tube defects:
prenatally, CT/MRI
98
Neuro Tube defects: Myelodysplasia (Spina Bifida) what cause-lack of what take what
Unknown cause -lack of folic acid take prenatal vitamins
99
Long term complications- potential for what pain limited problems w what what to lower extremities Neuro Tube defects: Myelodysplasia (Spina Bifida)
potential for joint pain, limited mobility, problems w bowel and bladder, paralysis to lower extremities,
100
cerebral palsy- abnormality where
Abnormality of the immature brain that occurs in the prenatal, perinatal or postnatal period
101
cerebral palsy- characterized by what abnormal what lack of what
abnormal muscle tone lack of coordination with spasticity- like cannot control bowel/bladder
102
cerebral palsy may be because of what can lead to what
May be because of hypoxic events pre birth Can lead to seuizures
103
cerebral palsy support who talk to who do what exercises
Support partents, pt/ot, range of motion
104
Cervical vertebra what functions
autonomic functions, breathing and diahpragm
105
thoracic vertabra regulates what moves what extremities
Temperature regulation, trunk extremities
106
lumbar vertabrae controls what
Controls lower extremites and bowel/bladder
107
dermatomes what are they how assess
parts where spinal nerve Is innervated assess hot/cold/ sensation
108
Spinal Cord Injury injury identified by where do what to spine determine what
identified by vertebral level immobilize spine determine the level of the injury
109
cervical cord injury Interventions- needs what Spinal Cord Injury
rapid intervention needs intubation
110
spinal cord injury manifestations what shocks x2
spinal shock neurogenic shock
111
Spinal Cord Injury surgery s d L s f insertion of what
stabilization, decompression laminectomy , spinal fusion, insertion of metal rods
112
spinal cord injury never do what what if you need to
never move pt log roll if you need to
113
spinal cord injury complications impaired m impaired g e ineffective c a
impaired mobility, impaired gas excahgne, ineffective breathing, contractures, atrophy
114
Spinal Cord Injury- spinal shock what is it
Temporary loss of function below level of injury
115
Spinal Cord Injury- spinal shock where is it f p loss of what x2 intentional what manifestations
below level of injury, flacid, paralysis, loss of reflexes, loss of sensation intestinal paralysis
116
Neurogenic shock manifestations what bp what hr what pulses what temp what urine output
hypotension bradycardia bounding pulses hypothermic oliguria
117
meds for neruogenic shock c p f p a
corticosteroids, pressors, fluids, ppi, analegesics
118
Cervical Spinal Cord Injury - complications needs what
diaphragm / phrenic nerve- intubation and mechanical ventilation.
119
Thoracic Spinal Cord Injury - complications need what administered
– abd. Muscles- Oxygen is administered to the patient with a thoracic-level injury
120
need to do what in paraylsysis prevents what
passive range of motion prevents disuase syndrome-done use it you lose it
121
Autonomic Dysreflexia above where is it deadly Spinal Cord Injury - complications
Above T6 / not able to control autonomic nervous system Can be fatal!
122
Autonomic Dysreflexia pounding what hr f / what vision what skin what bp Spinal Cord Injury - complications
Pounding headache, bradycardia, flushing , n/v, blurred vision, diahpretic skin severe hypertension
123
Autonomic Dysreflexia causes f b f I i Spinal Cord Injury - complications
full bladder feral impaction infection
124
Autonomic Dysreflexia treat what what schedule Spinal Cord Injury - complications
treat cause and symptoms are on Cath schedule
125
Spinal Cord Injury - complications I u/c skin
immobility urinary/ constipation asses skin
126
Herniated Intervertebral Disk when what happens
When the nucleus pulposus protrudes through weakened or torn annulus fibrosus of an intervertebral disk
127
Lumbar disk Manifestations: s Herniated Intervertebral Disk
sciatica- burning pain, numbness, tingling down one leg
128
Cervical disk manifestations- pain where p where Herniated Intervertebral Disk
pain in shoulder, neck and arm parethesia along dermatome
129
Herniated Intervertebral Disk-Diagnosis
: differentiate cause of back pain, X-ray, CT, EMG, myelogram
130
Herniated Intervertebral Disk Treatment-: medications to relieve pain and reduce swelling and muscle spasms- d I s
diazepam, ibuprofen /steroids,
131
Herniated Intervertebral Disk Conservative treatment
start w like physical therapy, losing weight and all that, then surgery do this first
132
Herniated Intervertebral Disk Surgical- L s f
laminectomy, spinal fusion,
133
Herniated Intervertebral Disk Surgical- nurses role n assessments d assessment what check c normal
- neuro assessments, dermatomes assessment, voiding checks, c&db , normal post op like vitals
134
CNS Infection includes what
CNS brain spinal cord meninges neural tissue blood vessel
135
Common causes: of CNS infections b v f p r
bacteria, viruses, fungi, protozoans rickettsiae
136
Meningitis- Infection that involves what
pia mater, arachnoid, subarachnoid space, cerebral spinal fluid
137
Meningitis Manifestations h n s pain where f p r what symptoms
: headache, neck stiffness, , pain in neck, fever, petechia, restless, flu like symptoms
138
Meningitis- 2 types
Acute purulent meningitis (bacterial) Acute lymphocytic meningitis (viral)
139
meningitis tests k/b l p
kernigs and brudzinskis lumbar puncture
140
Acute purulent meningitis (bacterial) tx w a d c what control
antibiotics, dexamethasone, corticosteroids, pain control
141
Acute lymphocytic meningitis (viral) tx w anti s p m
antivirals steroids pain meds
142
Encephalitis infection of where caused by what
Infection of the parenchyma of the brain or spinal cord Usually caused by viral organism following a viral infection
143
Encephalitis pathophysiology
Invasion of the brain tissue, reproduces inflammatory response (no exudate noted) degeneration of the neurons of the cortex (destruction of white matter) necrotizing hemorrhage, edema, & hollow cavities within the cerebral hemispheres
144
Encephalitis -> edema leads to what compression of what increased what possible what
compression of blood vessels and ↑ICP possible death
145
Encephalitis Manifestations f h s n r changes in
: fever, headaches, seuizire, nuchal rigidity, change in loc
146
Encephalitis dx m c need to figure out if what
mri, ct, need to figure out if bacterial or viral
147
Encephalitis-Are put on v p s p m anti
ventilator, profolol, and then steroids, pain meds, anti biotic/viral`
148
MYASTHENIA GRAVIS W E A K N E S S
W: Weakness of face E: Eyelid drooping A: Appearance mask-like K: Keeps choking N: No energy E: EOM weakness S: Slurred speech S: SOB
149
MYASTHENIA GRAVIS what is it affects what
Autoimmune disorder that affects the neurotransmitter acetylcholine
150
what does acetylcholine do
stimulates muscles
151
MYASTHENIA GRAVIS symptoms w f
weakness fatigue
152
MYASTHENIA GRAVIS risk for what dt what
for aspiration dt impaired swallowing
153
MYASTHENIA GRAVIS meds what anticholinesterase what immunosupreseants take when
anticholinesterase- (pyridostigmine and neostigmine), immunosuppressants- (prednisone take 30 mins before eating
154
MYASTHENIA GRAVIS monitor for what what s/s (HR, difficulty what x2)
Monitor for Myasthenic Crisis (Tachycardia, difficulty swallowing/breathing)
155
surgical tx for myasthenia gravis
Thymectomy
156
GUILLIAN-BARRE SYNDROME (GBS) what is it acute what
Acute autoimmune disease, acute inflammatory demyelinating disorder of the PNS
157
GUILLIAN-BARRE SYNDROME (GBS) Causes what from where
motor paralysis (usually ascending) from toes to head
158
GUILLIAN-BARRE SYNDROME (GBS) Cause is unknown but precipitating factors a I s v i
: acute infections, surgery, viral immunizations
159
GUILLIAN-BARRE SYNDROME (GBS) Manifestations p p what tingling if diapghtam is affected-worry about what
: pain, paralysis, face/jaw tingling if diaphragm is affected  breathing!
160
GUILLIAN-BARRE SYNDROME (GBS) Medications I g m anti v long term what
: Immune globulin, morphine, anticoagulants, vasopressors long term airway-intubation/trachea
161
TRIGEMINAL NEURALGIA- what is it-severe what
Severe, repetitive attacks of stabbing pain when the trigeminal nerve is stimulated-
162
TRIGEMINAL NEURALGIA- manifestaitons what type of pain where
severe stabbing, burning, ringing pain, wherever the nerve is at
163
TRIGEMINAL NEURALGIA usually from what could be from what
Usually from a vascular compression or demyelination of the nerve. Could be from trauma, dental/jaw infections, flulike illnesses, tumor, MS
164
TRIGEMINAL NEURALGIA Medications p m anti p
: pain meds- anticonvsulants- carbamaepizne, gapbapentin, prednisone
165
TRIGEMINAL NEURALGIA-if meds don’t control pain..
Possible surgery
166
FACIAL PARALYSIS (BELL’S PALSY) what does it look like
Acute paralysis that affects one side of the face. Similar to stroke symptoms but is not a CVA
167
FACIAL PARALYSIS (BELL’S PALSY) medications p anti a what care x3
Prednisone, antivirals, analgesics , eye care (artificial tears), face and mouth care,
168
FACIAL PARALYSIS (BELL’S PALSY) why PT what diet
Pt to help regain strength- can take over an year Soft diet to help chewing
169
FACIAL PARALYSIS (BELL’S PALSY) why Can happen in younger people looks like initially-then what
-in stressful times and acquire a viral infection tingling, blurred vision, then wake up w full bells
170
Corneal Abrasion- what is it tx w ( ep and a) EYE TRAUMA
-disruption of superficial epithelium of cornea- eye patch and antibiotic
171
EYE TRAUMA Burns- from what how tx
from heat, radiation or explosion- flush eye
172
Penetrating trauma- what is it do not do what may need what EYE TRAUMA
something that penetrates eye- do not put pressue, may need surgery
173
Blunt Trauma- lid ecchymosis- Subconctival hemorrhage- Hyphema- EYE TRAUMA
Lid ecchymosis- black eye Subconctival hemorrhage- rupture of blood vessel in eye Hyphema- bleeding in anterior chamber of eye
174
blunt trauma eye trauma what position e s
semi fowelrs. Eye sheild
175
eye trauma Orbital blowout fracture
eye may fall out
176
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA tumor where does what
Benign tumor of CN VIII Compresses the auditory nerve and affects the vestibular and cochlear branches
177
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA Manifestations t unilateral n v
: tinnitus, unilateral hearing loss, nystagmus, vertigo
178
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA How do we diagnose? c m
CT scan or MRI
179
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA how tx
Remove tumor in or