Scenario Test Flashcards
(64 cards)
1
Q
What is M.S.?
A
Multiple Sclerosis: autoimmune disorder of the CNS. Demyelination of nerve fibres in the brain, spinal cord and optic nerves.
2
Q
M.S. manifestations?
A
Symptoms manifest as motor, sensory, cerebellar, and emotional problems.
3
Q
What are sensory abnormalities in M.S.?
A
Tingling Numbness Parasthesias Patchy blindness (scotomas) Blurred vision Vertigo Tinnitus
4
Q
What is Lhermitte’s sign (M.S.)?
A
Sensory symptom described as an electric shock radiating down the spine and into the limbs with flexion of the neck.
5
Q
Potential complications of M.S.
A
Convulsive seizures
Dementia
6
Q
GI complications of M.S.
A
Dysphagia Trouble chewing Decreased sphincter control Incontinence Constipation
7
Q
Exacerbations in M.S. are triggered by?
A
Infection Trauma Immunization Childbirth Stress Climate change
8
Q
Types of drug therapy for M.S.
A
Corticosteroids Immunosuppressants Immunomodulators Cholinergics Anticholinergics Muscle relaxants
9
Q
Nursing interventions for M.S. clients
A
Help client to use assistive devices Do active ROM Perform stretching exercises Change position of client if bedridden Teach signs and symptoms of UTI
10
Q
M.S. diagnostic testing
A
Hx and physical examination CSF analysis Evoked response testing CT scan MRI MRS
11
Q
Normal blood pH range?
A
7.35 - 7.45
12
Q
Normal PaCO2 range?
A
35 - 45 mm Hg
13
Q
Normal bicarbonate (HCO3) range?
A
22 - 26 mEq/L
14
Q
Normal sodium (Na) range?
A
135 - 145 mmol/L
15
Q
Normal potassium (K) range?
A
3.5 - 5.0 mmol/L
16
Q
Normal blood urea nitrogen (BUN) range?
A
3.6 - 7.1 mmol/L
17
Q
Normal creatinine range?
A
44 - 133umol/L
18
Q
Goals for M.S. clients
A
Maximize neuromuscular functioning Maintain independence for as long as possible Manage fatigue Optimize psychosocial well-being Adjust to illness Reduce triggers for exacerbations
19
Q
What is Parkinson’s Disease (PD)?
A
Neurodegenerative disease of the basal ganglia in the CNS. PD is a movement disorder.
20
Q
What are characteristics of Parkinson’s Disease?
A
Slow movement (bradykinesia)
Rigidity
Tremor at rest
Impaired postural reflexes
21
Q
Types of drug therapy for PD?
A
Antiparkinsonians Dopaminergic Anticholinergic Antihistamine Monoamine Oxidase Inhibitors Catechol-O-Methyltransferase (COMT) Inhibitors
22
Q
Parkinson’s medications?
A
Levodopa
Benadryl
Comtan
Mirapex
23
Q
Goals for PD clients
A
Experience lower frequency of symptoms
Maximize neurological function
Maintain independence for as long as possible
Optimize psychosocial well being
24
Q
Nursing interventions for PD clients
A
Assist with ambulation Teach mobility and stretching exercises Massage patient's facial and neck muscles Increase fibre in diet Monitor swallowing ability
25
What is the role of dopamine in PD clients?
In PD, the dopaminergic neurons in the basal ganglia become damaged, resulting in a decrease of dopamine in relation to acetylcholine. This causes an imbalance of motor activity.
26
Clinical manifestations of PD?
Shuffling, propulsive gait
Changes in speech patterns
Flexed arms
Loss of postural reflexes
27
Parkinson's Triad?
Bradykinesia
Tremor at rest
Rigidity
28
What is dementia?
It is a collection of symptoms. Progressive decline in cognitive functioning. Can be caused by various diseases that affect the brain.
29
Normal magnesium (Mg) range?
0.65 - 1.05 mmol/L
30
Normal calcium (Ca) range?
2.2 - 2.58 mmol/L
31
Frontotemporal dementia (FTD)?
Formerly called Pick's Disease
Onset between 50 - 60 years
Degeneration of frontal lobe, temporal lobe, or both.
32
What is Creutzfeldt-Jakob Disease (CJD)?
Rare and fatal infectious brain disorder.
Abnormally folded prion protein
No treatment available
33
Symptoms of Creutzfeldt-Jakob disease
```
Memory lapses
Mood swings
Behaviour changes
Involuntary movements
Mental deterioration
Coma leading to death
```
34
What is vascular dementia?
AKA: Multi-infarct dementia
| Blood and oxygen supply to the brain is blocked, causing cell death.
35
What causes vascular dementia?
Single stroke
Multiple strokes
Results from ischemic, ischemic-hypoxic, or hemorrhagic brain damage caused by cardiovascular disease.
36
Types of drug therapy for dementia
```
Cholinesterase inhibitors
Selective serotonin reuptake inhibitors (SSRIs)
Atypical antipsychotics
Benzodiazepines
Anticonvulsants
```
37
Medications for dementia
```
Aricept
Zoloft
Celexa
Ativan
Risperdal
Tegretol
```
38
Mini-Mental Staus Exam (MMSE)
Orientation to time
Registration (3 word recall)
Naming objects
Reading
39
Interventions for dementia
```
Give one simple direction at a time
Identify usual patterns of behaviour
Assist/cue for ADLs
Maintain independence for as long as possible
Get into a routine of care
```
40
What is Alzheimer's Disease?
Chronic, degenerative, progressive disease of the brain.
41
Dementia is categorized into 5 strains. What are they?
```
Alzheimer's Disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
Creutzfeldt-Jakob disease
```
42
What is delirium?
State of acute mental confusion.
Common in older adults.
Medical emergency
43
3 subtypes of delirium
```
Hyperactive delirium (restlessness)
Hypoactive delirium (lethargy)
Mixed delirium
```
44
Drug therapy for delirium?
Antipsychotics (neuroleptic agents).
Haloperidol is the first-line of treatment
Benzodiazepines are contraindicated (unless delirium is caused by withdrawal)
45
List the 6 influencing factors on intracranial pressure (ICP)
```
Blood pressure
Cardiac function
intra-abdominal and intrathoracic pressure
Body position
Temperature
Blood gases (particularly CO2)
```
46
What is increased ICP?
Life-threatening
| Results from an increase in brain tissue, blood and/or CSF.
47
Risks associated with increased ICP
Brain ischemia and infarction
48
Nursing interventions for increased ICP
Head of the bed at 30 degrees or greater with head in a neutral position
Drug therapy (diuretics, anticonvulsants, antipyretics)
Decrease stimuli in room
Monitor vitals closely
Monitor intake and output
Passive/assistive ROM
49
What are seizures?
Paroxysmal, uncontrolled electrical discharge of neutrons in the brain. This disrupts normal functioning.
50
What is a tonic-clonic seizure?
Characterized by loss of consciousness and falling, to stiffening of the body (tonic phase) and subsequent jerking of limbs (clonic phase).
51
What are the phases of a seizure?
```
Prodromal phase (signs the precede a seizure)
Aural phase (sensory warning)
Ictal phase (full seizure)
Postictal phase (period of recovery)
```
52
What is status epilepticus?
State of continuous seizure or recurring seizures without regaining consciousness. This is a neurological emergency.
53
Drug therapy for seizure disorders?
Barbiturates (phenobarbital)
Benzodiazepines
Sodium channel blockers
54
Nursing interventions for client with seizure disorders
Loosen constrictive clothing
Following seizure, assess for trauma, weakness or paralysis
Patient teaching regarding med action adherence
55
Normal Hb levels
Males: 138 - 180 g/L
Females: 120 - 160 g/L
56
Normal Hct levels
Males: 0.37-0.49
Females: 0.36-0.46
57
Normal bilirubin level
5.1 - 17 mmol/L
58
Normal albumin level
35 - 48 g/L
59
Normal chloride level
95 - 105 mmol/L
60
Normal phosphate level
0.97 - 1.45 mmol/L
61
Normal glucose level
4 - 6 mmol/L
62
INR
0.81 - 1.2
63
PT (prothrombin time)
11 - 13 seconds
64
PTT (partial thromboplastin time)
25 - 35 seconds
