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Flashcards in Med surg exam Deck (56):
0

Polyethylene glycol and electrolytes

Is an osmotic agent.

1

Doctyl sodium sulfosuccinate ( colace)

Is a fecal softner

2

Bisacodyl sodium (dulcolax)

Is a stimulant relaxant

3

Magnesium hydroxide ( milk of magnesia)

Is a Saline agent

4

What is MS, amyotrophic sclerosis ( ALS) and myasthenia gravis (MG)

They are neurological diseases that typically result in impaired and worsening function of voluntary muscles.
MS & ALS affect nerve cells in the brain and spinal cord.
MG affects the neuromuscular junction.

5

What is MS

It is an autoimmune disorder characterized by development of plague in the white matter of the CNS. This plague damages the myelin sheath and interferes with impulse transmission between the CNS and the body.

6

ALS

Is a disease of the upper and lower motor neurons characterized by muscle weakness progressing to muscle atrophy and eventually paralysis and death.
ALS does not Involve autonomic changes, sensory alterations, or cognitive changes.

7

What is MG

It is an autoimmune disorder characterized by antibody- mediated loss of acetylcholine receptors at the neuromuscular junction, interfering with communication between motor neurons and innervated muscles.

8

Crede manuever

Placing manual pressure on abdomen over the bladder to expel urine

9

What are medications used to treat MS

Azathioprine ( Imuran) and cyclosporine ( sandimmune)
Immunosuppressive agents are used to reduce the frequency of relapses.
Prednisone- corticosteroids are used to reduce inflammation in acute exacerbations.
Dantrolene ( Dantrium), tizanidine ( zanaflex) baclofen ( lioresal) and diazepam ( Valium)- antispasmodics are used to treat muscle spasticity

10

What med can be used in severe cases of MS

INTRATHECAL baclofen

11

Interferon beta ( Betaseron)

Immunomodulators are used to prevent or treat relapses

12

Carbamazepine ( tegretol)

Anticonvulsants are used for paresthesia

13

Docusate sodium ( colace)

Stool softener used for constipation

14

Propantheline

Anticholinergics used for bladder dysfunction

15

What exactly is ALS

It is a degenerative neurological disorder of the upper and lower motor neurons that results in deterioration and death of the motor neurons.this results in progressive paralysis and muscle wasting that eventually causes respiratory paralysis and death. Cognitive function is usually not affected.

16

What is the other name for ALS

Lou Gehrig's disease... After the baseball player who died of this in 1941.
Death usually occurs due to respiratory failure within 3-5 yrs of the initial manifestations.
There is no cure

17

Risk factors for MS

20-40 years of age
Woman
Genetic
Environmental factors include smoking, lack of vitamin D exposure, and exposure to Epstein Barr virus.

18

Because MS, is an autoimmune disease, what factors triggers relapse

Viruses and infectious agents
Cold climates
Physical injury
Emotional stress
Pregnancy
Fatigue
Extreme temps
Hot shower or bath

19

What are the risk factors for developing ALS

Men
40-70 years of age

20

What are objective findings of a person with ALS

Muscle weakness, usually begins in one part of the body
Muscle atrophy
Dysphagia
Dysarthria
Hyperreflexia of deep tendon reflexes

21

What are lab test to diagnose ALS

Increased creatine kinase ( CK-BB) level

22

What are diagnostic procedures to diagnosis ALS

Electromyogram ( EMG)- reduction in number of functioning motor units of peripheral nerves.

Muscle biopsy- reduction in number of motor units of peripheral nerves and atrophic muscle fibers.

23

What are medications used to treat ALS

Rilozole ( Rilutek) is a glutamate antagonist that can slow the deterioration of motor neurons by decreasing the release of glutamic acid. It must be taken early in the disease process and will add approx. 2-3 months of life to the clients lifespan.

Baclofen ( Lioresal), dantrolene sodium ( Dantrium), diazepam ( Valium)
Are antispasmodics used to decrease muscle spasticity

24

What are complications of ALS

Pneumonia can be caused by respiratory muscle weakness and paralysis ncontributing to ineffective airway exchange

Respiratory failure may necessitate mechanical ventilation.

25

What is MG

Myasthenia gravis is a Progressive autoimmune disease that produces severe muscular weakness.
It is characterized by periods of exacerbations and remission.
Muscle weakness improves with rest and worsens with increased activity

26

What are risk factors of MG

Coexisting autoimmune disorder
Frequently assoc with hyperplasia of the thymus gland

27

What are subjective symptoms of MG

Progressive muscle weakness
Diplopia
Difficulty chewing and swallowing
Respiratory dysfunction
Bowel and bladder dysfunction
Poor posture
Fatigue after exertion

28

What are objective physical findings of a person with MG

Impaired respiratory status
Decreased swallowing ability
Decreased muscle strength
Incontinence
Droopy eyelids

29

What are diagnostic tests performed to diagnose MG

Tensilon testing- baseline assessment of cranial muscle strength is done
Electromyography- shows the neuromuscular transmission characteristics of MG.

30

What is atropine the antidote for

Atropine is the antidote for edrophonium ( bradycardia, sweating, and abdominal cramps.)

31

What are medications used to treat MG

Anticholinesterase is the 1st line in therapy.
Pyridostigmine ( Mestinon) and neostigmine ( Prostigmin) are used to increase muscle strength. It inhibits the breakdown of acetylcholine and prolongs its effects.
Immunosuppressants- because MG is an autoimmune disease, immunosuppressants decrease the production of antibodies.

32

What is bile

Bile is used for the digestion of fats
It is produced in the liver and stored in the gallbladder

33

What are risk factors of SLE

Nephritis
Oral ulcers
Very fragile skin
Ulcers on skin

34

What are tests to determine SLE

Blood tests

35

S&s of cholecystitis

Feeling of fullness
Cholesterol
Pigment stones
Dark urine
Pale stool
Jaundice
Itchiness, warmth on skin
RUQ PAIN RUQ PAIN. RUQ PAIN

36

What are risk factors of cholecystitis

Woman
Oral contraceptives
Estrogens or clofibrate
Meds known to ^ biliary levels
Cholesterol saturation
Increased age
GI DISEASE
Diabetes
Obesity/rapid wt. loss

37

What is treatment of cholecystitis

Decrease intake of fatty foods

38

What are diagnostics to diagnose cholecystitis

ERCP
ABDOMINAL X RAY
CHOLECYSTOGRAPHY
BILIRUBIN LEVELS
ULTRA SOUND
^ WBC
^ CHOLESTEROL LEVELS

39

What are s&s of crohns

Diarrhea
Abdominal pain
Anorexia
Wt.loss
Nutritional deficiencies

40

What is treatment for crohns

Sedatives
Anti diarrheal
Anti peristaltic meds
Amino salicylates ( sulfalazine)
Corticosteroids
Immunosuppressants

41

What tests determines whether a person has crohns

Proctosigmoidoscopy
Stool examination
Barium study
^ WBC ^ ESR ^ CRP
⬇️ HCT ⬇️ HGB ⬇️ albumin

42

What are s&s of ulcerative colitis

10-20 stools
LLQ PAIN LLQ PAIN LLQ PAIN
Fever
Vomiting
Abdominal distention
Hyperactive bowel sounds
Hypocalcemia
Rectal bleeding

43

What is treatment of ulcerative colitis

Steroids
Immunosuppressants
Anti inflammatory
Surgical interventions
Colon resection
Colostomy/ illeostomy

44

What tests determine ulcerative colitis

Endoscopy
Colonoscopy
Barium enema

⬆️ WBC ⬆️ ESR ⬆️ CRP
⬇️ albumin ⬇️ HCT ⬇️ HGB

45

Where does the genetic predisposition of MS come from

It is indicated by the presence of a specific cluster ( halo type) of human leukocyte antigens on the cell wall.mits presence may increase susceptibility to factors such as viruses,mthat teigger that autoimmune response activated in MS.

46

What does the RR course of MS involve

Relapsing remitting...with each relapse recovery is usually complete; however, residual deficits may occur and accumulate mover time.

47

What does the primary progressive course of MS involve

Disabling symptoms steadily increase, with rare plateaus and temporary minor improvement.

48

What are signs and symptoms of MS

PAIN, most ppl with MS also take opioids.
Paresthesia, dysesthesias, and proprioception loss.
Muscle Spasticity- usually occurs in in the lower extremities and can include loss of abdominal reflexes.
Ataxia ( impaired coordination of movements) and tremor
Bladder, bowel and sexual dysfunction

49

What do secondary complications of MS include

Urinary tract infections
Constipation
Pressure ulcers
Contracture deformities
Dependent pedal edema
Pneumonia
Reactive depression
And osteoporosis.

50

What is treatment for MS

Analgesics
Antiimmune therapy
Interferon beta 1a ( rebif) and interferon 1b ( Betaseron) are administered SC every other day.
Another preparation of interferon : avonex, is administered IM once a week

51

What are side effects of all interferon beta meds

Flulike symptoms that can be managed with acetaminophen and ibuprofen and resolve after a few months

Additional side effects include; potential liver damage
Fetal abnormalities and depression

52

What med is the key agent in treating acute relapse in the RR course of MS

IV methylprednisolone, they key agent in treating acute relapse in the RR course shortens the duration of relapse.it eceprts anti inflammatory effects by acting on T cells and cytokines, it is administered 1g IV daily for 3-5 days followed by an oral taper of prednisone. Side effects include mood swings, wt. gain, and electrolyte imbalances.

53

Mitoxantrone ( Novantrone)

Is used for MS.
It is administered by IV infusion every 3 months.
It can reduce the frequency of clinical relapses in patients with secondary progressive or worsening RR MS.
patients must be very closely monitored for side effects and there is a maximum life time dosage that can be used.

54

What are medications used for the specific symptoms of MS

Baclofen ( lioresal) {GABA agonist}- is used to treat muscle spasticity
Benzodiazepines- diazepam, tizanidine ( Zanaflex), and dantrolene ( Dantrium) may also be used to treat muscle spasticity

Meds used to treat ataxia include; beta blockers ( propranolol)
The anti seizure gabapentin ( Neurontin) and benzodiazepines ( clonazepam)

55

What may be used to acidify the urine making bacterial growth less likely

Vitamin C ( ascorbic acid)