Neuro/Autoimmune (Module 1) Flashcards

Question

MAO-B (Selegiline) (PD)

Answer 1

taken with levodopa; increases dopamine levels *helps with the wearing off effect of levodopa* **avoid foods with tyramine (cheese and aged, smoked or cured foods/sausage, red wine, beer) to prevent severe headache and mega hypertension and should continue restrictions for 14 days after drug is discontinued**

Answer 2

stimulate the release of dopamine and prevent its reuptake

Answer 3

**only for patients that haven’t responded to other therapy** • ablative procedures • deep brain stimulation (DBS)-surgical choice • cell transplantation

Answer 4

destroys a small portion of the Globus pallidus thalamotomy pallidotomy

Answer 5

electrode implanted in the thalamus; current delivered through a generator **decreases tremors and involuntary movements**

Answer 6

fetal tissue transplants are experimental

Answer 7

• no neuroprotective neurorestorative treatment available • main medical management: **supportive and symptomatic treatment**

Answer 8

• aspiration pneumonia (**swallowing precautions, PT/OT, dietary/speech consult**) *maintain weight with high calorie and high protein supplements, prevent aspiration* • altered cognition (**safe environment (no throw rugs, electric razor), freeze gait issue (*1 step back, 2 forward*), ADL/independence maintenance (exercise, assistive devices, etc.), extra time for activities, fostering communication (depression, self esteem), allow extra time for Q’s and encourage client to speak slowly and pause a lot, drug therapy, exercise programs/PT**) • OH • DVT/embolism • constipation • pneumonia (increase calories and protein) • pressure ulcers (immobility!!)

Answer 9

• home care preparation • self management education • health care resources • palliative care • neurologist • social worker • long term care • PT/OT/SLP

Answer 10

• decisional conflict r/t whether to have children (*encourage testing for family*) • aspiration pneumonia • altered cognition (dementia, memory deficits)/mobility (**Suicide prevention with depression (1), any issues with low body weight needs encouragement of 3 meals a day and necessary dietary supplements (2), eventually will need help with all ADLs, confined to bed and unable to speak; able to understand language and has awareness of family/friends (3), encourage planning for residential and EOL care (4))** • expressive dysphagia • PT USES WHITEBOARD NOT RN

Answer 11

resistance to passive movement of the extremities; cogwheel, plastic, lead pipe

Answer 12

manifested by a rhythmic interruption of the muscle movement

Answer 13

mildly restrictive movement

Answer 14

total resistance to movement

Answer 15

• chronic, progressive, neurodegenerative with NO CURE, UNKNOWN CAUSE/RISK • **targets the CNS and brain; loss of voluntary movement control, weakness, spasticity and flaccidity** • *patients suffer from lack of physical ability*

Answer 16

• chronic, progressive, neurodegenerative, NO CURE! AUTOIMMUNE NOT FATAL! • **targets brain and spinal cord (myelin sheath), demyelination of white matter leads to decreased flow of nerve impulses** • *patients suffer from more cognitive dysfunction than those with ALS* sx worse in extreme heat and cold, stress, infection fatigue, pregnancy remissions and exacerbations

Answer 17

• multiple factors • changes in immunity are most likely etiology • colder climates

Answer 18

• most die within 3-5 years when symptoms first start, only about 10% of people survive for 10+ yrs • **causes progressive muscle weakness and wasting, lose ability to speak, eat, move, and breathe (paralysis of respiratory muscles)** • fatigue • *muscle atrophy (wasting away and tongue) and muscle weakness by spasticity and hyperactive reflexes* • twitching (fasciculations) of face and tongue • **dysarthria (uncoordinated or slurred speech)** • **dysphagia** • stiff and clumsy gait • abnormal reflexes

Answer 19

• no cure, progressive; over time may progress to tetraplegia (normal life expectancy); fatigue, muscle spasticity • blurred/double vision (diplopia) • scotomas (patches of blindness in peripheral) • Uhthoffs sign (temp bad vision commonly seen after exertion or heat exposure) • nystagmus, tinnitus • pain/parasthesia • hypoalgesia (decreased sensitivity to pain) • areflexic (flaccid) or spastic bladder • decreased sexual dysfunction • **intention tremors when performing activity, changes in gait**

Answer 20

rare (40-60 y.o, more common in men)

Answer 21

ages 20-50 (1 mil in US), more common in white woman of Northern European ancestry (2x)

Answer 22

• no definitive test • diagnosis based on **med history, neuro exam, symptoms** • lab tests to rule out other metabolic conditions

Answer 23

• CSF reveals elevated protein lvl, a slight increase in WBCs and IgG • MRI plaques of brain and spine • evoke potential testing (give stimulation and see if the sense is decreased)

Answer 24

• continuity of care if needed • exacerbating factors • family coping skills • sexual dysfunction concerns • depression • nutrition • ADLs

Answer 25

• riluzole (Rilutek) • Edaravone (Radicava) • muscle relaxants

Answer 26

reduces molecular stimulation preventing overstimulation and brain damage; decreases glutamate resulting in less death of brain cells **tachycardia** **edema** **dizziness** **drowsiness** **GI disturbances (liver toxicity, DIB, rash, muscle/joint pain)**

Answer 27

antioxidant, reduces oxidative stress **blisters** **itching, skin irritation** **cough** **confusion** **tachycardia** **weakness** **easy bruising** **GI disturbances** **DIB, A.E, glycosuria, respiratory failure**

Answer 28

immunosuppressants/anti-inflammatories (secondary infections) • interferon beta 1a/1b • glatiramer acetate • medical weed • dexamethasone (Decadron) • Muscle Relaxants: diazepam (*valium benzodiazepine*), dantrolene (*monitor liver values, AST/ALT*), baclofen (*avoid stopping abruptly due to risk of seizure, hallucinations and rhabdomyolysis*) • Dalfampridine (Ampyra): improves gait/walking • Steroids (Dexamethasone (Decadron)): used for relapses, must taper off, increased risk for infection

Answer 29

immunomodulator with antiviral effects; injectables; WATCH OUT FOR FLU-LIKE SYMPTOMS

Answer 30

injection site reaction (SQ) rotate injection sites!! GI disturbances weight gain confusion/nervousness depression edema difficulty swallowing excessive sweating rash flu-like symptoms

Answer 31

decreases spasticity, muscle stiffness, pain can cause mental decline and dizziness

Answer 32

steroid anti-inflammatory for managing relapses (infection, hyperglycemia, don’t stop abruptly)

Answer 33

• death anxiety (*impending progressive loss of function leading to death*) • palliative care for symptom management, home health care, EOL planning, hospice • psychosocial support • ineffective breathing pattern r/t compromised respiratory function, monitor breathing!

Answer 34

• neurosensory/motor function baseline (with exacerbations, may not recover 100% function) • psychosocial support-depression, emotional liability • UTI prevention (hydration, bathroom schedule, bowel and bladder training) • promote cognitive function • eye patches for diplopia • group care and activity planning for energy conservation • exercise planning to avoid fatigue and overheating • swallowing precautions • decrease risk of injuries (safe environment, no high impact activities, PT/OT) • remains free of infection as a result of drug therapy affecting immunity or disease process • maintains optimal mobility and function as a result of managing fatigue and pain • maintains adequate visual acuity and cognition to function independently • assistive devices

Answer 35

• tracking voiding schedule and gradually lengthen • toileting training w/schedule and restroom assistance • dietary changes • med management • pelvic floor exercises

Answer 36

pain is behind browbone and/or cheekbones

Answer 37

pain is in and around one eye

Answer 38

pain is like a band squeezing the head

Answer 39

pain, nausea, and visual changes are typical of classic form

Answer 40

• recurrent episodic head pain that lasts 4-72 hrs • throbbing, intense, unilateral pain that can be accompanied by nausea, light/sound sensitivity • genetics and triggers • **cerebral artery vasodilation leads to prostaglandins released leading to brain tissue inflammation**

Answer 41

• photophobia/phonophobia • nausea and vomiting • stress and anxiety • **unilateral pain**, often behind one ear or eye • history of headaches • alterations ins ADLs (4-72 hrs) • w/aura: vision changes • OA: aura w/o pain

Answer 42

• hrs to days prior to headache (aware it’s coming) • fatigue, nausea • irritability • mood changes/depression • appetite changes/food cravings • difficulty sleeping and focusing • photo/phonophobia

Answer 43

• 5-60 min prior to headache • **visual disturbances (light flashes, bright spots)** • acute confusion • loss of vision • numbness, tingling, weakness, dizziness • speech changes • brainstem aura

Answer 44

• 4-72 hrs (third stage-dull HA) • second stage- severe, throbbing, incapacitating • unilateral typically • moderate-severe • throbbing • light and or sound sensitivity • n/v • made worse with movement

Answer 45

• 24-48 hrs following headache • mood changes • difficulty focusing and concentrating • fatigue • residual headache • brain fog • tiredness

Answer 46

• all ages (women most likely) family history • *may be associated with other conditions like colds, allergies, stress, muscle tension* • overweight/obese • fasting/ low glucose • high BP and cholesterol • hx of stroke or CAD • psych disorders (depression, anxiety) • oral contraceptives • some drugs (opiates, barbiturates, triptans) *at risk for stroke and epilepsy*

Answer 47

• neuroimaging if neuro symptoms are present or older than 50 yrs new onset • CT/MRI/EEG (r/o other diagnoses like tumor, MS, aneurism) • most don’t require labs or imaging

Answer 48

1. prevention (*trigger avoidance, preventive drugs like beta blockers*) 2. abortive therapy 3. trigger avoidance (*tyramine, preservatives, artificial sweeteners, diary with exposures and migraine history*) 4. complimentary and integrative health therapies 5. PREVENTATIVE: BOTOX AND BETA BLOCKERS (lower BP and HR)

Answer 49

initiate during aura phase or as soon as the headache starts NSAIDS, acetaminophen antiemetics (metoclopramide) for n/v

Answer 50

• triptan preparations (sumatriptan, zolmitriptan, eletriptan) to produce vasoconstriction effect **contraindicated in heart disease** • ergotamine preparations with caffeine to narrow blood vessels and reduce inflammation • isometheptene (vasoconstriction) in combo with caffeine when other meds don’t work

Answer 51

pain and aura subsiding, increased muscle spasms and myalgia **older adult: visual migraine, aura w/o pain**

Answer 52

• pain is aggravated by physical activity • **unilateral pulsing pain as well as photophobia, phonophobia, n/v** • **persists for 4-72 hrs, often occurring in early AM, during stress, premenstrual tension or fluid retention**

Answer 53

neuro sx for >7 days, imaging may show ischemic infarction

Answer 54

for frequent HA or when other therapies are ineffective • NSAIDS • **beta blockers: take even when asymptomatic for prevention to prevent vascular changes** • botox

Answer 55

• focus on pain management during HA (dark environment, HOB elevated, meds) • HA diary for patterns and triggers/trigger avoidance • avoid foods with tyramine and MSG • manage anger and conflict • avoid glare and flickering lights • adequate sleep/rest • avoid environmental triggers like odors • yoga, meditation, exercise, acupuncture, external trigeminal nerve stimulator (wearable headband that stimulates branches associated with HA, not to be used more than 20 min/day)

Answer 56

• chronic and progressive autoimmune disorder • **inflammatory and immune attacks occur against multiple self tissues and organs** • *progressive loss of tissue integrity through excessive inflammation and overactive immunity leads to organ failure and death* arthritis and joint pain vasculitis and rash kidney damage to glomular and tubular basement membranes hematologic problems CV problems

Answer 57

• polygenetic susceptibility to gene-environmental interacts resulting in autoimmunity • some will have cutaneous lupus erythematosus (CLE), but 70-80% will develop SLE • significant multiorgan morbidity • **triggering events include infections, hormones, environmental exposures to toxins/pollutants/etc. (UV radiation)** • *most common cause of death CKD and CV collapse, with good treatment patients survive 20+ years*

Answer 58

• women 30-44 yr; 10x more likely than men • **incidence declines after menopause which suggests estrogen as a trigger** • *black americans 8:1 to white americans*

Answer 59

slow onset (6 yrs from first symptoms to diagnosis) • **chronic fatigue** • recurrent fevers with unknown origin • persistent joint/muscle swelling/pain, tenderness, weakness • alopecia • blurred vision • pleuritic pain (pericarditis, pleural effusions) • anorexia, weight loss, anemia • depression • **butterfly rash** • Raynauds • **kidney damage and hematological problems** • decreased O and protein in urine • HTN and peripheral edema

Answer 60

• red, macular, facial rash over the cheeks and nose in the shape of butterfly • coin-shaped lesions (discoid rash) on face, scalp, sun-exposed areas • sensitivity to sunlight (photosensitivity) with rash development after exposure • chronic lesions on mucous membranes of mouth and throat • nonerosive arthritis of 2+ peripheral joints with pain and swelling • inflammation of serosal membranes, especially pericarditis and pleurisy • kidney changes with persistent casts and protein in urine • neurologic problems like seizures/psychosis without previous history • hematologic problems with hemolytic anemia (most common), decreased WBC (leukopenia), decreased lymphocytes (lymphopenia), decreased platelets • immunity problems such as autoantibodies to cell nuclear structures and false-+ results of serologic tests for syphilis • presence of antinuclear antibodies (ANAs)

Answer 61

• skin biopsy (lupus cells and cellular inflammation) • antinuclear antibodies (ANAs) positive in 95% patients • ESR elevated • BUN/Creatinine elevated • UA positive for protein, casts, RBCs • CBC (pancytopenia)

Answer 62

• NSAIDS (**contraindicated with renal disease**) • Corticosteroids (-sone, -lone) • Immunosuppressants (DMARDS) • antimalarial

Answer 63

prednisone is anti-inflammatory and immunosuppressant (*fluid retention, HTN, impaired kidney function, hypergylcemia, skin atrophy, pathological fractures*) **don’t stop abruptly (DEATH), risk for fracture, watch for hyperglycemia** caution with elderly

Answer 64

DMARDS (methotrexate), azathioprine, belimumab; monitor for infection secondary to immunosuppression and liver enzymes (AST/ALT) **reverse isolation, toxicity, bone marrow suppression, liver toxicity, hold vaccines 30 days before**

Answer 65

hydroxychloroquine suppresses synovitis, fever, fatigue, and risk of UV related lesions (*frequent eye exams*)

Answer 66

• HTN, edema • Renal dysfunction (urine output) • Diminished breath sounds (pleural effusion) • Tachycardia and chest pain (pericarditis) • rubor, pallor, cyanosis hands/feet (vasculitis, vasospasm, Raynauds) • arthralgias/myalgias/polyarthritis (joints/connective tissue) • changes in mental status (psychosis/paresis/seizures) • nutritional status • BUN, creatinine, urinary output for renal involvement

Answer 67

• pain/mobility/fatigue • assess VSs (BP) • systemic complications and renal impairment; pericarditis and CV impairment • watch for Lupus Nephritis (kidneys) • watch breath sounds

Answer 68

• wide-brim hat, long sleeves/pants when outdoors • avoid UV exposure (sunscreen) • mild soaps/shampoos • pat skin dry/no rubbing • monitor for rashes/lesions and use lotion • avoid drying agents (alcohol, scrubs, powders, cleaning products) • steroid cream for rashes • report peripheral/preoribital edema • report S/S of infection (typical/atypical) • reverse isolation • learn the risks of pregnancy while treating SLE • avoid large crowds • frequent eye exams

Answer 69

• small frequent meals if anorexia/anemia is a concern and between meal supplements • encourage a heart-healthy diet • limit salt intake for HTN and fluid retention secondary to steroid therapy • emotional/psychological support • support groups • skin protection • exercise plan (mobility/ADLs) • avoiding smoking/alcohol

Answer 70

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in LOC, motor or sensory ability and/or behavior **etiologies include trauma, brain tumors, birth injuries**

Answer 71

chronic disorder in which repeated unprovoked seizure activity occurs (*3/4 of cases are idiopathic; **may be imbalance of electrical neuronal activity; imbalance of neurotransmitters (especially gamma aminobutyric acid (GABA))***) auras all meds cause drowsiness, ataxia and decreased CNS

Answer 72

IDIOPATHIC no specifiable cause or underlying lesion often associated with genetics

Answer 73

• underlying brain lesion (tumor or trauma) • metabolic disorders • acute alcohol withdrawal • electrolyte disturbances • high fever • stroke • head injury • substance abuse • heart disease (arrhythmias) *seizures resolve when underlying etiology resolves*

Answer 74

• 3 broad categories (*generalized (5, both hemispheres), partial (focal/local, manifestations vary based on area affected), unclassified*)

Answer 75

individual may appear to be staring into space and/or have jerking or twitching muscles *can be precipitated by hyperventilation or flashing lights*

Answer 76

causes stiffening of muscles of the body, generally those in the back and extremities

Answer 77

causes repeated jerking movements of muscles on both sides of the body

Answer 78

causes jerks/twitches of the upper body, arms or legs

Answer 79

causes a loss of normal muscle tone; will fall down or may drop head involuntarily

Answer 80

causes stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness *may be associated with biting tongue, incontinence* **postictal: muscle soreness, tired**

Answer 81

continuous or rapidly recurring seizures; MED EMERGENCY that causes hypoxemia leading to brain damage, arrhythmias, and acidosis *seizure activity lasting longer than 5 min* **IV-push lorazepam (Ativan)/diazepam (Valium) as 1st line therapy (or phenytoin (Dilantin), fosphenytoin (Cerebyx); may require endotrach for airway protection**

Answer 82

protect patient from injury, maintain airway (*O2 therapy, suction equipment, turn patient onto their side*), time the seizure

Answer 83

apply O2 and clear airway check blood glucose attempt to reorient patient (*postictal period varies*)

Answer 84

• number, timing, pattern of seizures • pre-ictal phase (*does pt acknowledge an aura or presenting symptoms?*) • other med history • substance abuse history (*alcohol use-last drink?*) • diagnostics (*EEG, CT, MRI, SPECT/PET, blood glucose*)

Answer 85

**all can cause drowsiness, ataxia and CNS depression** • levetiracetam (Keppra): no need to monitor blood lvls, CBC instead • phenytoin (Dilantin) IV • carbamazepine (Tegretol) • Divalproex (Depakote)

Answer 86

causes gingival hyperplasia, bone marrow suppression, rash, multiple drug interactions, IV vesicant monitor blood lvl and CBC therapeutic range: 10-20 mcg/mL (narrow!)

Answer 87

causes bone marrow suppression monitor blood lvl and CBC therapeutic range is 4-12 mcg/mL

Answer 88

**causes hepatotoxicity**, bone marrow suppression monitor blood lvls, CBC, **LFTs** therapeutic range is 50-100 mcg/mL

Answer 89

• resection of seizure focus • requires precise diagnosis of seizure foci • usually hospitalized for continuous EEG monitoring • vagal nerve stimulation (pacemaker for the brain)… **goal is to prevent seizures by sending regular, mild electrical impulses to the brain; stimulator placed under skin in upper chest and electrode surgically placed in left neck around vagus nerve**

Answer 90

• don’t stop anticonvulsants abruptly • need for blood monitoring • avoid hazardous activities • avoid alcohol, fatigue, loss of sleep • Medic-Alert bracelet • Epilepsy Foundation as resource

Answer 91

• protect pt from injury • do not force anything into the patients mouth during seizure activity • turn pt to side to prevent aspiration and keep airway clear • remove any objects that might injure pt • suction oral secretions if possible w/o force • loosen any restrictive clothing pt has • don’t restrain or try to stop pt movement, guide movements if necessary • record time the seizure began and ended and frequency if necessary • after seizure, check O2, airway and BG; reorient patient (postictal phase)

Answer 92

reversible cerebral ischemia, “warning sign” usually precedes thrombotic stroke 1 in 3 people experiencing TIA eventually have a stroke, half of occur within a year **temporary neurologic dysfunction, brief interruption in cerebral blood flow that resolve in 24 hours** *most common cause is CAROTID ARTERY STENOSIS*

Answer 93

smoking DM age inadequate nutrition hypercholesterolemia oral contraceptive use excessive alcohol use illicit drug use

Answer 94

5th leading cause of death, women have higher incidence “stroke belt” (8 SE states with higher mortality, 20%)

Answer 95

**A**spirin use when appropriate **B**P control **C**holesterol management **S**moking cessation

Answer 96

**A**ge of at least 60 years **B**P of at least 140/90 **C**linical TIA features **D**uration of symptoms

Answer 97

surgical to promote perfusion (**carotid angioplasty and endarterectomy**) meds (**antiplatelet drugs like aspirin or Plavix**) bp management controlling diabetes lifestyle changes (**smoking cessation, physical activity, diet**)

Answer 98

an interruption of blood flow to the brain med emergency!! (*-pam first than -toin*) **as certain areas of the brain become damaged or infarcted, the control of various bodily functions may be affected**

Answer 99

**most common; occur as a result of an obstruction within a blood vessel that supplies blood to the brain** thrombotic (*artherosclerosis*) embolic (*a fib*) CT w/o contrast; no blood means ischemic TPA thrombolytic within 4 hrs

Answer 100

**interruption in blood vessel integrity leading to bleeding into brain tissue or subarachnoid space** intracerebral hemorrhage (ICH) (*severe/sustained HTN*) subarachnoid hemorrhage (SAH) (*ruptured aneurysms + AVM rupture*) aneurysm arteriovenous malformation (AVM) (*congenital abnormality, collection of thin walled vessels*) CT w/o contrast, if blood is present; NO TPA!

Answer 101

similar to TIA but do not resolve headaches may be present with hemorrhagic strokes due to increasing ICP

Answer 102

tangled mass of abnormal blood vessels in which arterial blood flows directly into venous system, 6% of all SAH *slight male prevalence, 20-40 yrs* symptoms similar to increased ICP **treatments are surgical resection, coiling, radiation**

Answer 103

s/s vary depending on location of vessel involved and extent of occlusion **unilateral weakness, numbness, difficulty talking and understanding, severe headaches with no known cause**

Answer 104

first priority is to ensure pt is transported to stroke center focused/rapid assessment protocol: what do we need to know first? **always a risk that LOC will change so need to prioritize information gathering**

Answer 105

LOC Glasgow Coma Scale (GCS) cranial nerves pupils motor and sensory deep tendon reflexes cerebellar function for coordination NIH stroke scale

Answer 106

vitals (*HR, BP*) monitor for arrhythmias EKG respiratory drive rate and rhythm

Answer 107

• inadequate perfusion to the brain due to interruption of arterial blood flow and possible ICP increase • decreased mobility and possible need for assistance to perform ADLs due to neuromuscular or impaired cognition • aphasia + dysarthria due to decreased circulation in brain (aphasia) or facial muscle weakness (dysarthria) • sensory perception deficits due to altered neurologic reception and transmission

Answer 108

emergent non contrast CT may require MRI/MRA non emergently cerebral angiogram carotid duplex EKG AND TEE (echocardiogram) **rule out other causes like migraine, partial seizures, subdural hematoma, brain tumor, cardiac syncope, hypoglycemia, demyelination disease**

Answer 109

improving cerebral perfusion monitoring for increased intracranial pressure promoting ADL and mobility ability managing changes in sensory perception

Answer 110

1. assess ABCs and vitals 2. O2 if pt is hypoxemic (<94% sat) 3. IV 4. blood samples for blood count, coagulation studies and glucose; give dextrose is hypoglycemic and insulin if glucose >300; give thiamine is pt has history of alcohol use or is malnourished 5. assess using neurological screening assessment like NIH stroke scale 6. **order a CT brain scan w/o contrast and have it read quickly** 7. obtain 12 lead ECG and assess for arrhythmias 8. **don’t delay CT scan to obtain ECG, which is then taken to identify MI or arrhythmia as cause for embolic stroke (life threatening arrhythmias can happen with or follow a stroke)** 9. within 45 min of pt arrival, specialist must decide based on CT scan if hemorrhage is present

Answer 111

note that the pt is NOT a candidate for fibrinolytic therapy arrange for consultation with neurologist or neurosurgeon consider transfer if available

Answer 112

determine if pt is a candidate for fibrinolytic therapy repeat NIHSS

Answer 113

most important factor to determine if altephase is appropriate period of time between symptom onset and arrival time to stroke center FDA approved use of tPA within 3 hours of onset American Stroke Association endorsed 4.5 hrs if no exclusion criteria are present

Answer 114

age older than 80 anticoagulation therapy baseline NIHSS score greater than 25 history of both stroke and diabetes evidence of active bleeding BP greater than 185 systolic or 110 diastolic history of cerebral bleed elevated PT/INR

Answer 115

1. mechanical embolectomy MERCI retrieval system (**for pts that don’t qualify for tPA or fail therapy; present within 8 hrs of stroke onset**) 2. intra-arterial thrombolysis (**TPA delivered directly to thrombus within 6 hrs of onset**) 3. carotid artery angioplasty with stenting

Answer 116

**interventional nurses are responsible for pre,peri, and postprocedural nursing care** 1. assessing for prevention, early identification and monitoring signs of neurological and hemodynamic incline 2. ensure informed consent is signed 3. administration of procedural meds 4. documentation 5. transition of care communication with ED, transferring organizations and ICU 6. baseline neuro vascular assessment of pts extremities (*pulses distal to anticipated arterial access site, capillary refill, skin color, temp; Allen/Barbeau test for baseline assessment of radial artery for trans radial approach*)

Answer 117

1. document sheath removal time and time of hemostasis 2. frequent vitals and neurological monitoring (*every 15 min for 2 hrs, every 30 min. for 6 hrs, and every hr for 16 hrs*) 3. assist with hemostasis (*may be achieved through manual pressure or closure device*) 4. monitor for vascular access complications (**arterial spasms, pain, swelling, bruising, erythema, bleeding, hematoma, pulsatile mass, drainage from puncture site**) 5. assessment of pulses distal to arterial access site, cap refill, skin color and temp, sensation and motor function 6. changes from baseline assessment are verified and communicated to proceduralist or admitting team 7. frequent vascular access site and neuro vascular assessments (*every 15 min for 1 hr, every 30 min for 1 hr, every hr for 4 hours*)

Answer 118

post procedural monitoring… • frequent vitals • neurological assessment (new stroke like symptoms) • neck site for bleeding or hematomas

Answer 119

• has adequate cerebral perfusion to avoid long term disability • maintains BP and glucose within a safe and prescribed range • performs self care and mobility activities independently w or w/o assistive devices • learns to adapt to sensory perception changes if present • communicates effectively or develops strategies for effective communication • has adequate nutrition and avoids aspiration

Answer 120

left CVA usually; can have global aphasia **Brocas area= expressive aphasia** **Wernickes area= receptive aphasia**

Answer 121

maintain ROM position to prevent contractures prevent foot drop fall precautions transfer to strong side address functional incontinence

Answer 122

place objects in pts visual field approach pt from unaffected side teach pt to turn head to affected side and stimulate affected side teach pt to use mirror to survey affected side

Answer 123

screen ALL stroke pts (**assess gag reflex and swallowing function**) initiate speech consult (**NPO until swallow study, barium swallow study may be indicated**) check for pocketing modified consistency diet HOB to 90° tube feeding may be indicated if pt is aspirating

Answer 124

PT: mobility, gait, transfer, strengthening OT: ADLs, coping with cognitive and perceptual defects (*adaptive equipment*) speech therapy: evaluating and treating aphasia, dysarthria and dysphagia

Answer 125

neurological deficits related to lvl and degree of injury complete (*all inner action below lvl of injury eliminated*) or incomplete (*some function or movement below lvl of injury*) can cause cauda equina (saddle numbness)

Answer 126

hyperflexion (*accelerate forward, injury to cervical like a rear end collision*) hyperextension axial loading/vertical compression (*broken vertebral pieces from divings/falls*) excessive rotation penetrating trauma

Answer 127

trauma (MOST COMMON) (**MVC, falls, acts of violence, sports related**) malignancies/pathologies

Answer 128

18,009 new SCIs every year in the US 80% young white males, average age is 43 yrs old **cervical cord injuries more common than thoracic or lumbar cord injuries**

Answer 129

**above C4 requires mechanical ventilation** all cause respiratory insufficiencies (*decreased cough, vital capacity and high risk of atelectasis and pneumonia*)

Answer 130

initial injury/disruption of cord (spinal shock)

Answer 131

decreased reflexes and flaccid paralysis below level of injury due to acute SCI *complete but temporary loss of motor, sensory, reflex, and autonomic function (48 hrs-several weeks)* **flaccid paralysis and bladder, paralytic ileus, loss of sensation, decreased or absent reflexes** spasticity may emerge after spinal shock resolves

Answer 132

on going damage from ischemia, inflammation, toxic metabolites, edema neurogenic and hypovolemic shock

Answer 133

high risk with injury above T6; disruption of SNS HEMODYNAMIC PHENOMENON!! (but can be present alongside spinal shock) **hypotension, bradycardia, Poikilothermia** (hemo instability) *may require atropine, pacing or dopamine, potential need for acute airway management*

Answer 134

above T6; stimulus below lesion causes an imbalanced and unopposed reflex sympathetic stimulation; counter balancing from baroreceptors blocked *usually visceral/cutaneous stimuli (impaired sensation puts pt at risk)* **distended bladder, fecal impaction, tight clothing, extreme temps are risks**

Answer 135

headache, blurred vision, diaphoresis, flushing, tachycardia **severe hypertensive crisis** *can progress to status epilepticus or CVA, MI, cerebral hemorrhage and death*

Answer 136

elevate HOB and remove tight clothes monitor BP (administer meds if needed via IV) **remove noxious stimuli** close neurological assessment

Answer 137

immobilize injury with backboard and neck care maintain ABCs stat x-ray spine CT/MRI establish IV assess LOC, head injury and other injuries comprehensive neuro assessment (**touch, pain, muscle strength**) high dose methylprednisolone (Solu-Medrol) to lower edema maintain adequate perfusion (**between 80-90, may require dopamine continuous infusion**) stabilization (**application of traction/halo; surgical decompression with laminectomy and instrumentation**)

Answer 138

potential for CV instability (shock and autonomic dysreflexia) due to loss or interruption of sympathetic innervation or hemorrhage 1. monitor HR and treat bradycardia (atropine for HR drop to 50-60) 2. maintain MAP between 80-90 (**titrate dopamine/other vasoactive drugs for acute management**) 3. maintain fluid volume status 4. dextran (**plasma expander that increases capillary blood flow within spinal cord**) 5. DVT prophylaxis (SCDs and Lovenox)

Answer 139

potential for respiratory distress/failure due to aspiration, decreased diaphragmatic innervation and decreased mobility 1. coughing and deep breathing exercises 2. ventilator management 3. monitor O2 sat and ABGs

Answer 140

1. auscultate bowel sounds for ileus (**NG tube for ileus aka gastric decompression**) 2. stress ulcer prophylaxis (PPI) ie pantoprozole 3. TPN until begin oral feeding 4. high protein/high cal diet 5. initiate bowel training program

Answer 141

1. catheter care (*foley vs straight cath?*) 2. monitor output 3. prevent UTI 4. possibly initiate catheterization 5. monitor BUN and creatinine (**for and prevent bladder distention**)

Answer 142

risk for decreased mobility and sensory perception due to spinal cord damage and edema; high risk for pressure ulcers 1. pin care for traction/halo 2. infection prevention for any surgical sites

Answer 143

assess… • grieving process • body image, self-concept, role performance • family dynamics? • anger and depression • loss of control • sexuality, family planning? • prepare for rehab (**physical training; some rehabs for SCI also incorporate intimacy counselors**)

Answer 144

home care self management education (**mobility, pressure injury prevention, ADLs, bowel/bladder training, sexuality education, prevention of autonomic dysreflexia**) health care resources (**interdisciplinary, specialized SCI center, maximize independence**)

Answer 145

prevention education (**reduce high risk behaviors, implement safety precautions**) rehab (**restoration of function, level of independence, vocational rehab**)

Answer 146

• exhibits no deterioration in neurologic status • maintains a patent airway, a physiologic breathing pattern, adequate ventilation • doesn’t experience a CV accident event (*shock, hemorrhage, autonomic dysreflexia*) or receives prompt treatment if it does • doesn’t experience secondary SCI, including VTE and heterotropic ossification • is free from complications of decreased mobility • performs mobility skills and basic ADLs as independently as possible w or w/o use of assistive devices