Pn2 Final Cp

Question 1

o Parkinson’s Disease

Cause:

Answer 1

degeneration of substantia nigra, resulting in too little dopamine and too much acetylcholine.

Question 2

Parkinson’s

s/s:

Answer 2

Parkinson’s s/s:
Tremor, muscle rigidity, slow/shuffling gait, bradykinesia (slow movement), masklike expression, drooling, difficulty swallowing.

Question 3

Parkinson’s Nursing care:

Answer 3

Monitor swallowing food intake,

thicken food,

sit patient upright to eat,

have suction equipment available.

Encourage ROM and exercise,

assist with ADL’s.

Question 4

Parkinson’s disease Meds:

Answer 4

Levodopa/carbidopa (increases dopamine levels),

benztropine (decreases acetylcholine levels)

Question 5

Non-reversible dementia, resulting in memory loss problems with judgement and changes in personality.

Answer 5

o Alzheimer’s dementia

Question 6

Stages of Alzheimer’s/dementia

Stage 1-7

Answer 6

Stage1: no impairment
Stage2: Forgetfulness, no memory issues
Stage3: Mild cognitive deficits, short term memory loss noticeable to family members
Stage4: Personality changes, obvious memory loss
Stage5: Assistance with ADL’s necessary
Stage6: Incontinence (fecal, urinary), wandering
Stage7: Impaired swallowing, ataxia, no ability to speak.

Question 7

Nursing care:

For Alzheimer’s/ dementia

Answer 7

Nursing care:
Maintain structured environment.
Provide short directions, repetition.
Avoid overstimulation.
Use single-day calendar.
Provide frequent reorientation.
Maintain routine toileting schedule.

Question 8

Alzheimer’s dementia Home Safety:

Answer 8

REMOVE SCATTER RUGS.
Install door locks, good lighting (particularly on stairs)
Mark step edges with colored tape, remove clutter.

Question 9

Alzheimer’s dementia Meds:

Answer 9

DONEPEZIL (prevents breakdown of Ach, improves ability to do ADLs)

other meds to manage symptoms:(antipsychotics, antidepressants, anti-anxiety meds)

Question 10

S/s: PHOTOPHOBIA, NAUSEA/VOMITING, UNILATERAL PAIN (USUALLY BEHIND ONE EYE OR EAR).

Can happen with or with out aura (visual disturbances, numbness/tingling)

Pain persists for 4-72 hours.

Answer 10

o Migraines

Question 11

Migraine Nursing care:

And meds:

Answer 11

provide cool, dark, quiet environment.

Teach patient to avoid triggering foods, reduce stress levels.

Meds: NSAIDs (mild migraine), antiemetics (for n/v), sumatriptan or ergotamine for more severe migraines.

Question 12

Migraine Risk factors:

Answer 12

Allergies, bright lights, fatigue, stress, anxiety, menstrual cycles, certain foods (MSG, tyramine, nitrates).

Question 13

Inflammation of meninges (membranes around brain and spinal cord)

Answer 13

o Meningitis

Question 14

s/s of meningitis:

Answer 14

s/s of meningitis: headache, nuchal (neck) rigidity, photophobia, nausea, vomiting, positive KERNIGs and BRUDZINKIs signs (look up), fever, altered LOC, tachycardia, and seizures.

Question 15

Difference between viral and bacterial meningitis

Answer 15

Viral type is most common and can resolve with out treatment.

Bacterial type of very contagious and deadly with a high mortality rate.

Question 16

Dx for meningitis?

Answer 16

Lumbar puncture- to obtain CSF to dx meningitis. (Fluid taken from spinal canal for analysis)

Can also diagnose multiple sclerosis, syphilis, meningitis, infection in CSF.

Question 17

Prevention for meningitis:

Answer 17

Immunizations help prevent bacterial meningitis.

(HIB), which is given to infants at 2 months?

MCV4 vaccine is given to students living in dorms.

Question 18

Meningitis dx Procedure: instructions for pt

Before-
During-
After-

Answer 18

Before- have patient void,

During- position the patient in cannon ball position on their side, or have patient stretch over table while sitting.

Post-procedure- Patients should lay flat afterwards for several hours.

If the dura puncture site does not heal, CSF may leak, resulting in headache (administer pain meds and encourage increased fluid intake) Epidural blood patch can be used to seal off the hole.

Question 19

CFS- spinal fluid will appear how with bacterial or viral? And elevated labs?

Answer 19

cloudy with bacterial meningitis as well as have decreased glucose content.
Viral type will have clear VSF.
Both- will have elevated protein and WBC’s.

Question 20

Nursing care for meningitis:

Type of precautions, where to bring/place patient, what to avoid , precautions?

Answer 20

Nursing care:

Droplet precautions for 24 hours until antibiotics are administered.

-provide a quiet room, low light, HOB 30 degrees, monitor for increased ICP, tell pt to avoid coughing/sneezing to decrease ICP, and implement seizure precautions.

Question 21

Uncontrolled electrical discharge of neurons in brain.

Answer 21

Seizures

Question 22

Seizure that May be preceded by aura.

3 Phases:
Tonic episode:

Clonic Episode:

Postictal phase:

Answer 22

Tonic Clonic

3 Phases:
Tonic episode: stiffening of muscles, loss of consciousness.

Clonic Episode: 1-2 minute of rhythmic jerking of extremities

Postictal phase: confusion, sleepiness

Question 23

chronic seizures (2 or more)

Answer 23

Epilepsy

Question 24

Risk factors for epilepsy:

Triggering factors:

Answer 24

Risks- fever, cerebral edema, infection, toxin exposure, brain tumor, hypoxia, alacohol/drug withdrawl, fluid or electrolyte imbalances.

Triggers- Stress, fatigue, caffeine, flashing lights

Question 25

Type of seizure-Loss of consciousness for a few seconds for a few seconds. Key features: blank staring, eye fluttering, lip smacking, picking at clothes.

Answer 25

Absence

Question 26

Type of seizure: | brief stiffening of extremities

Answer 26

Myoclonic

Question 27

Type of seizure : loss of muscle tone, results in FALLING.

Answer 27

Atonic

Question 28

Type of seizure: | Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes.

Answer 28

Status epilepticus:

Question 29

Diagnosis for seizure

Answer 29

Diagnosis: EEG to identify origin of seizure.

Question 30

** Nursing care: During seizure: Post seizure: Meds:

Answer 30

** Nursing care: During seizure: TURN PATIENT TO THE SIDE, loosen restrictive clothing, DO NOT INSERT AIRWAY OR RESTRAIN PATIENT, document onset/duration of seizure. Post seizure: check vital signs, neurological checks, reorient patient, seizure precautions, determine possible trigger. Meds: anti-seizure meds such as phenytoin.

Question 31

Surgeries for seizures:

Answer 31

Vagal nerve stimulator, craniotomy to remove brain tissue causing seizures.

Question 32

What is the coma scale used After seizure to determine Level of Consciousness 3-8: 9-12: 13 and up ? Meaning - Scores depend on what?

Answer 32

Use glascows coma scale if head injury occurs: 3-8 = severe injury of head, 9-12= moderate injury, 13 and up = normal. Scores depend on Eye opening, verbal responses, and motor responses.

Question 33

Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes. is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a potential complication of all types of seizures. Seizures lasting longer than how long can cause death!?

Answer 33

o Status epilepticus Repeated seizures activity within 30 min, or a single seizure lasting more than 5 minutes. 10 minutes can = death

Question 34

Common causes of status epilepticus include:

Answer 34

* Sudden withdrawal from antiepileptic drugs * Infection * Acute alcohol or drug withdrawal * Head trauma * Cerebral edema * Metabolic disturbances

Question 35

Nursing Safety Priority Critical Rescue Convulsive status epilepticus must be treated promptly and aggressively! How? Priority? What may occur if untreated? Drug of choice?

Answer 35

Establish an airway and notify the health care provider or Rapid Response Team immediately if this problem occurs! Establishing an airway is the priority for this patient's care: - Intubation by an anesthesia provider or respiratory therapist may be necessary. - Administer oxygen as indicated by the patient's condition. - establish IV access with a large-bore catheter and start 0.9% sodium chloride. - The patient is usually placed in the intensive care unit for continuous monitoring and management. - Blood is drawn to determine arterial blood gas levels and to identify metabolic, toxic, and other causes of the uncontrolled seizure. - Brain damage and death may occur in the patient with tonic-clonic status epilepticus. - If Left untreated, metabolic changes result, leading to hypoxia, hypotension, hypoglycemia, cardiac dysrhythmias, or lactic (metabolic) acidosis. - Further harm to the patient occurs when muscle breaks down and myoglobin accumulates in the kidneys, which can lead to renal failure and electrolyte imbalance. This is especially likely in the older adult. - The drugs of choice for treating status epilepticus are IV-push lorazepam (Ativan, Apo-Lorazepam) or diazepam (Valium). Diazepam rectal gel (Diastat) may be used instead. - Lorazepam is usually given as 4 mg over a 2-minute period. This procedure may be repeated, if necessary, until a total of 8 mg is reached. Emergency Care: Acute Seizure and Status Epilepticus Management. Seizures occurring in greater intensity, number, or length than the patient's usual seizures are considered acute. They may also appear in clusters that are different from the patient's typical seizure pattern. Treatment with lorazepam (Ativan, Apo-Lorazepam) or diazepam (Valium, Meval, Vivol, Diastat [rectal diazepam gel]) may be given to stop the clusters to prevent the development of status epilepticus. IV phenytoin (Dilantin) or fosphenytoin (Cerebyx) may be added

Question 36

Nursing Safety Priority Drug Alert - To prevent additional tonic-clonic seizures or cardiac arrest, a loading dose of what is given?

Answer 36

IV phenytoin (Dilantin) is given, and oral doses are administered as a follow-up after the emergency is resolved. - Initially give phenytoin at no more than 50 mg/min using an infusion pump. - If the drug is piggybacked into an existing IV line, use only normal saline as the primary IV fluid to prevent drug precipitation. - Be sure to flush the line with normal saline before and after phenytoin administration

Question 37

syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above). spinal injuries above T6: stimulation of sympathetic nervous system with inadequate response from parasympathetic nervous system. Symptoms: EXTREME HYPERTENSION, severe headache, blurred vision, diaphoresis.

Answer 37

o Autonomic dysreflexia

Question 38

Nursing actions for autonomic dysreflexia:

Answer 38

Sit patient up, notify provider, DETERMINE CAUSE (DISTENDED BLADDER, FECAL IMPACTION, TIGHT CLOTHING, UNDIAGNOSED INJURY), treat cause (catheterize patient, remove impaction, remove tight clothing), administer antihypertensives.

Question 39

occurs immediately as the cord's response to the injury. The patient has complete but temporary loss of motor, sensory, reflex, and autonomic function that often lasts less than 48 hours but may continue for several weeks. Spinal shock is NOT the same as neurogenic shock. Perform a detailed assessment of the patient's what?? status to determine the level of injury?? The neurologic level is determined by evaluation of the ?

Answer 39

Spinal shock MOBILITY and SENSORY PERCEPTION evaluation of the zones of sensory and motor function, known as dermatomes and myotomes

Question 40

o Spinal cord injuries ??-injuries below T1, resulting in paralysis/paresis of lower extremities ??-injuries in cervical region, resulting in paralysis/paresis of all 4 extremities

Answer 40

Paraplegia- injuries below T1, resulting in paralysis/paresis of lower extremities Quadriplegia- injuries in cervical region, resulting in paralysis/paresis of all 4 extremities

Question 41

occurs after SCI for several days to weeks. s/s: low BP, dependent edema, temperature regulation issues. Upper motor neuron injuries (above L1/L2): spastic muscle tone, spastic neurogenic bladder. Lower motor neuron injuries (below L1/L2): flaccid muscle tone, flaccid neurogenic bladder. Meds:

Answer 41

Neurogenic shock Meds: Glucocorticoids (reduces spinal cord edema), vasopressors (treats low BP during neurogenic shock) muscle relaxers (baclofen, dantrolene), stool softeners (in addition to bowel and bladder schedule).

Question 42

In acute SCI, monitor for a decrease in ?? The presence of these changes is considered an emergency and requires immediate communication with the primary health care provider using SBAR or other agency-approved protocol for notification. Document these assessment findings in the electronic -health record.

Answer 42

SENSORY PERCEPTION from baseline, especially in a proximal (upward) dermatome and/or new loss of motor function and MOBILITY.

Question 43

Diagnosis of / manifestations of thyroid disorders

Answer 43

H

Question 44

Diagnosis of manifestations/ tx of parathyroid disorders in

Answer 44

?

Question 45

Manifestations of malnutrition/ risk factors for malnutrition

Answer 45

?

Question 46

Appropriate infusion of tube feedings /TPN

Answer 46

?

Question 47

Risks for obesity

Answer 47

?

Question 48

Role of nurse in preparing client for gastric bypass

Answer 48

?

Question 49

Complications with gastric bypass

Answer 49

?

Question 50

albumin

Answer 50

?

Question 51

Inadequate production of thyroid hormones t3 t4 by the thyroid gland

Answer 51

Hypothyroidism

Question 52

S/s of hypothyroidism Labs:

Answer 52

Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle finger nails, depression Decreased t3 and t4 , increased TSH, anemia

Question 53

Causes of hypothyroidism Primary Secondary Tertiary

Answer 53

Most common type -issue with thyroid gland - autoimmune disorders Issue with pituitary gland- insufficient TSH- tumor Issues with hypothalamus- produces improper Amt of TRH

Question 54

Hypothyroidism nursing care Meds

Answer 54

Encourage proper rest periods Low calorie, high fiber and increased activity to promote weight loss and prevent constipation Non fiber laxatives- interferes with levothyrixine absorption Provide extra blankets and increase room temp No electric blankets Meds- levothyrixine (synthroid) start low dose and gradually increase. Take one hour before breakfast with full glass Of water

Question 55

Complications of hypothyroidism Causes: Symptoms of complications: Nursing care for complications:

Answer 55

Hyperthyroidism due to too much synthroid Myexedema coma - severe hypothyroidism Causes: untreated Hypothyroidism, infection/illness, Stopping Synthroid abruptly S/s: hypoxia, decreases cardiac output, decreased LOC, Bradyycardia, hypotension , hypothermia Nursing care: maintain airway, monitor ECG, warm patient , administer large doses of Synthroid

Question 56

Excess thyroid hormones (too much) T3 and T4 released from the thyroid gland, resulting in hyper metabolic state

Answer 56

Hyperthyroidism

Question 57

Causes of hyperthyroidism Primary Secondary Tertiary

Answer 57

Primary -issues with the thyroid gland,Graves disease is most common, auto immune issue or Thyroid nodule has hyper secretion of T3 and T4 Secondary – issues with the pituitary gland. Anterior pituitary gland produces too much TSH due to tumor Tertiary – issues with the hypothalamus. Hypothalamus produces too much TRH

Question 58

Signs and symptoms of hyperthyroidism Labs

Answer 58

Tachycardia, hypertension, heat intolerance is key, EXOphthalmos,Weight loss, insomnia, diarrhea, warm and sweaty skin Labs-Increased T3 and T4, decreased TSH

Question 59

Nursing care for hyperthyroidism

Answer 59

Nutrition is key to increase patient calories, protein intake, and monitor I and Os , weight Exophthalmos- tape eye lids closed, provide eye lubricant

Question 60

Hyperthyroidism meds

Answer 60

PTU Beta blockers Iodine solution’s- mix with juice to mask taste Radio active iodine- stay away from children for 2-4 days, flush toilet 3 times, do not share toothbrush , use disposable plates/utensils

Question 61

Hyperthyroidism complications Cause Symptoms

Answer 61

Thyroid storm-Excessively high levels of the thyroid hormones, with high mortality rate Causes – infection, stress, DKA Symptoms – hypertension, chest pain, dysrhythmias, dyspnea, delirium

Question 62

Surgery for hyperthyroidism What to inform patient

Answer 62

Thyroidectomy-Removal of thyroid gland Patient will need a ride replacement therapy for the rest of their life

Question 63

Thyroid synthesis pathway

Answer 63

The hypothalamus produces TRH – thyroid releasing hormone TRH causes the anterior pituitary gland to produce TSH – thyroid stimulating hormone TSH causes the thyroid gland to produce T3 and T4-thyroid hormones that control metabolism in the body

Question 64

Cortisol synthesis pathway

Answer 64

Hypothalamus purchases CRH – cortisol releasing hormone CRH causes the interior pituitary gland to produce ACTH (adrenocorticotropic hormone) (ACTH causes the adrenal vortex to produce cortisol. - A steroid hormone that controls metabolism, immune function, and body’s response to stress

Question 65

Inadequate secretion of hormones by adrenal cortex (Sex hormones, cortisol, aldosterone)

Answer 65

Addisons

Question 66

Causes of Addisons Primary Secondary

Answer 66

Primary- adrenocortical insufficiency: Damage or dysfunction of adrenal cortexRelated to autoimmune dysfunction’s, tumors Secondary- Pituitary dysfunction: pituitary tumor or hypophysectomy

Question 67

S/s of addisons Labs

Answer 67

Weight loss, hyperpigmentation- bronze skin, lethargy, n/v , hypotension, dehydration *increased potassium and calcium Decreased sodium, glucose, cortisol

Question 68

Dx Addisons how Primary-results Secondary-results

Answer 68

ACTH simulation test Administer AC TH, measure Cortizone response after 30 minutes, one hour Primary-Cortisol levels do not rise Secondary-Cortisol levels do rise

Question 69

Nursing care for Addisons

Answer 69

Give steroids-prednisone/hydrocortisone Fluids Treat hyperkalemia-sodium polystyrene sulfonate, insulin with glucose, calcium, bicarbonate Treat hypoglycemia- food, supplemental glucose

Question 70

Complications of Addisons

Answer 70

Addisons crisis - Rapid onset, medical emergency. Due to infection/trauma or abrupt discontinuation of steroids

Question 71

Over production of cortisol by the adrenal cortex

Answer 71

Cushings

Question 72

Dx for cushings

Answer 72

Dexamethasone suppression test

Question 73

Nursing care for Cushings

Answer 73

* diet: Decrease sodium intake, increase and take a potassium, calcium and protein Maintain safe environment due to increased risk of fracture’s Prevent infection Protect patient skin from break down

Question 74

Cushings meds : Procedures/surgeries:

Answer 74

Spironolactone - potassium sparring diuretic Ketoconazole- adrenal corticosteroid inhibitor Procedures/surgeries : cytotoxic agents for tumors Hypophysectomy- removal of pituitary gland Adrenalectomy - removal of adrenal gland- hormone replacement therapy needed , monitor for adrenal crisis related to drop in cortisol levels

Question 75

Cushings causes Primary Secondary

Answer 75

Primary : Adrenal dysfunction – oversecretion of cortisol by the adrenal cortex related to hyperplasia or tumor Secondary- Pituitary dysfunction- Oversecretion of AC TH by the anterior pituitary gland related tumor Long-term steroids use for chronic conditions

Question 76

Signs and symptoms of Cushing’s syndrome Labs

Answer 76

Increased infections, thin and fragile skin, edema, wt gain, Moon face, Buffalo hump, increased abdominal girth, hypertension, tachycardia, bone pain fractures, hyperglycemia, gastric ulcers, acne, hirsutism Elevated cortisol levels in saliva * Increase glucose, sodium levels * Decreased potassium, calcium levels

Question 77

Thyroidectomy - post procedure nursing care

Answer 77

Place Patient in high Fowlers position Monitor for hemorrhaging. Check the dressing and back and neck for bleeding. Support head and neck with pillows/sand bags Teach patient to avoid neck flexion or extension Have a tracheostomy supplies available at bed side *Monitor for signs of parathyroid gland damage(low calcium , numbness around mouth , toes, muscle twitching , positive chvosteks or trousseus signs Administer calcium gluconate for treatment of hypocalcemia Administer steroids to decrease post op edema

Question 78

Hypophysectomy post op nursing care

Answer 78

Monitor for s/s of CSF leak : Halo sign in drainage (clear in center, yellow on edges ) - sweet tasting drainage - clear drainage from nose - headache Teach patient to avoid activities increased ICP: coughing, sneezing,Blowing nose, bending at Waist, Straining during bowel movements, increase fiber intake Decrease sense of smell expected for 3 to 4 months Do not brush teeth for two weeks but can floss and rinse mouth

Question 79

Spinal cord injury - how to move patient What is the purpose of it

Answer 79

Log roll- A couple people at had a bed, brace and mobilization at neck purpose of logrolling is to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury.